Provider Demographics
NPI:1912039041
Name:WANN, SHARON LINDE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHARON
Middle Name:LINDE
Last Name:WANN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74105-2648
Mailing Address - Country:US
Mailing Address - Phone:918-743-2928
Mailing Address - Fax:918-743-2295
Practice Address - Street 1:1321 E 35TH ST
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74105-2648
Practice Address - Country:US
Practice Address - Phone:918-743-2928
Practice Address - Fax:918-743-2295
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK46671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice