Provider Demographics
NPI:1396779708
Name:DURRETT, SHARON JEANE (DMD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:JEANE
Last Name:DURRETT
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 1:11908 SHELDON RD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3643
Mailing Address - Country:US
Mailing Address - Phone:813-920-1935
Mailing Address - Fax:813-920-1954
Practice Address - Street 1:11908 SHELDON RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3643
Practice Address - Country:US
Practice Address - Phone:813-920-1935
Practice Address - Fax:813-920-1954
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN153931223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics