Provider Demographics
NPI:1326189010
Name:ROBERT A. SHARP, D.M.D., P.A.
Entity Type:Organization
Organization Name:ROBERT A. SHARP, D.M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:904-998-7707
Mailing Address - Street 1:5101 GATE PKWY STE 4
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7276
Mailing Address - Country:US
Mailing Address - Phone:904-998-7707
Mailing Address - Fax:904-998-7759
Practice Address - Street 1:5101 GATE PKWY STE 4
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7276
Practice Address - Country:US
Practice Address - Phone:904-998-7707
Practice Address - Fax:904-998-7759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 99101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty