Provider Demographics
NPI:1881084432
Name:MARTY, SHARLENE (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARLENE
Middle Name:
Last Name:MARTY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36388 DETROIT ROAD
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:OH
Mailing Address - Zip Code:44011-1588
Mailing Address - Country:US
Mailing Address - Phone:440-934-9090
Mailing Address - Fax:440-934-9094
Practice Address - Street 1:36388 DETROIT ROAD
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:OH
Practice Address - Zip Code:44011-1588
Practice Address - Country:US
Practice Address - Phone:440-934-9090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-03
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.020462122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist