Provider Demographics
NPI:1205847753
Name:ZERTANNA, SHARON KAY
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAY
Last Name:ZERTANNA
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 1:19075 NW TANASBOURNE DR
Mailing Address - Street 2:300
Mailing Address - City:HILLSBORO
Mailing Address - State:OR
Mailing Address - Zip Code:97124-5860
Mailing Address - Country:US
Mailing Address - Phone:503-531-1700
Mailing Address - Fax:
Practice Address - Street 1:13662 SW WHITMORE RD
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123
Practice Address - Country:US
Practice Address - Phone:503-628-2922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1064126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant