Provider Demographics
NPI:1467613380
Name:SHARPE, KELSEY SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELSEY
Middle Name:SUE
Last Name:SHARPE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 90211
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57109-0211
Mailing Address - Country:US
Mailing Address - Phone:605-212-6121
Mailing Address - Fax:
Practice Address - Street 1:521 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57104-5948
Practice Address - Country:US
Practice Address - Phone:605-367-8046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-23
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND125791223G0001X
SDTEMP298122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice