Provider Demographics
NPI:1881814283
Name:SHARKEY, WILLIAM PATRICK (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:PATRICK
Last Name:SHARKEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:342 CATHERINE ST
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-3057
Mailing Address - Country:US
Mailing Address - Phone:509-525-9474
Mailing Address - Fax:509-525-4723
Practice Address - Street 1:342 CATHERINE ST
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-3057
Practice Address - Country:US
Practice Address - Phone:509-525-9474
Practice Address - Fax:509-525-4723
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6019237091223G0001X
WADE00008075122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA93-0953511OtherFEDERAL TAX ID