Provider Demographics
NPI:1659587624
Name:SHEETS, DAVID WARD (DMD,LLC)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WARD
Last Name:SHEETS
Suffix:
Gender:M
Credentials:DMD,LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 THAYER CTR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-1138
Mailing Address - Country:US
Mailing Address - Phone:301-334-1111
Mailing Address - Fax:
Practice Address - Street 1:4000 THAYER CTR
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-1138
Practice Address - Country:US
Practice Address - Phone:301-334-1111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD7113302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization