Provider Demographics
NPI:1811149123
Name:SHARP, W. THOMAS JR (DDS)
Entity type:Individual
Prefix:
First Name:W.
Middle Name:THOMAS
Last Name:SHARP
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2220 MOUNTAIN BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-2958
Mailing Address - Country:US
Mailing Address - Phone:510-482-2799
Mailing Address - Fax:510-482-2336
Practice Address - Street 1:2220 MOUNTAIN BLVD.
Practice Address - Street 2:SUITE 205
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-2905
Practice Address - Country:US
Practice Address - Phone:510-482-2799
Practice Address - Fax:510-482-2336
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17853122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist