Provider Demographics
NPI:1760571301
Name:LISTER, SHARON EVETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:EVETTE
Last Name:LISTER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:EVETTE
Other - Last Name:LISTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS , PC
Mailing Address - Street 1:368 E GRANT RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-5783
Mailing Address - Country:US
Mailing Address - Phone:520-623-9479
Mailing Address - Fax:520-623-0044
Practice Address - Street 1:368 E GRANT RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-5783
Practice Address - Country:US
Practice Address - Phone:520-623-9479
Practice Address - Fax:520-623-0044
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ60451223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice