Provider Demographics
NPI:1558535799
Name:SHARP, RAYMON NEWTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMON
Middle Name:NEWTON
Last Name:SHARP
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 1:410 S PEARL AVE
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64801-2541
Mailing Address - Country:US
Mailing Address - Phone:417-626-7100
Mailing Address - Fax:417-624-9817
Practice Address - Street 1:410 S PEARL AVE
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64801-2541
Practice Address - Country:US
Practice Address - Phone:417-626-7100
Practice Address - Fax:417-624-9817
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO014419122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist