Provider Demographics
NPI:1902200793
Name:SHARB, JENA
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:SHARB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:278 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:OH
Mailing Address - Zip Code:45701-2310
Mailing Address - Country:US
Mailing Address - Phone:740-592-4431
Mailing Address - Fax:740-594-2370
Practice Address - Street 1:278 W UNION ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-2310
Practice Address - Country:US
Practice Address - Phone:740-592-4431
Practice Address - Fax:740-594-2370
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH31.013118124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist