Provider Demographics
NPI:1487184677
Name:SHARBONO, DANIEL CONRID (DDS)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:CONRID
Last Name:SHARBONO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 BAYOU LN
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-2429
Mailing Address - Country:US
Mailing Address - Phone:318-286-3295
Mailing Address - Fax:
Practice Address - Street 1:2406 DUVAL DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201
Practice Address - Country:US
Practice Address - Phone:318-699-0101
Practice Address - Fax:318-699-0142
Is Sole Proprietor?:No
Enumeration Date:2017-06-19
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA67711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice