Provider Demographics
NPI:1831460252
Name:SHARP, MARTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTHA
Middle Name:
Last Name:SHARP
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 1:17340 PICKWICK DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6181
Mailing Address - Country:US
Mailing Address - Phone:540-338-3186
Mailing Address - Fax:
Practice Address - Street 1:17340 PICKWICK DR
Practice Address - Street 2:SUITE 100
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6181
Practice Address - Country:US
Practice Address - Phone:540-338-3186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014105921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice