Provider Demographics
NPI:1710247424
Name:THOMAS, SHARA MONIQUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARA
Middle Name:MONIQUE
Last Name:THOMAS
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 1:6495 NEW HAMPSHIRE AVE STE 108
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3288
Mailing Address - Country:US
Mailing Address - Phone:301-270-5100
Mailing Address - Fax:301-270-5524
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE STE 108
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3288
Practice Address - Country:US
Practice Address - Phone:301-270-5100
Practice Address - Fax:301-270-5524
Is Sole Proprietor?:No
Enumeration Date:2012-05-29
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162691223G0001X
DCDEN10012631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06705000Medicaid
DC078727500Medicaid