Provider Demographics
NPI:1912900390
Name:FELLER, SHARON PATRICIA (DDS, FAGD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:PATRICIA
Last Name:FELLER
Suffix:
Gender:F
Credentials:DDS, FAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N ELMIRA AVE
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-9617
Mailing Address - Country:US
Mailing Address - Phone:479-280-1920
Mailing Address - Fax:
Practice Address - Street 1:US NAVAL HOSPITAL
Practice Address - Street 2:VIA CONTRADA BOSCARIELLO
Practice Address - City:GRICIGNANO DI AVERSA
Practice Address - State:CE
Practice Address - Zip Code:81030
Practice Address - Country:IT
Practice Address - Phone:081-811-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE83761223G0001X
AR48321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5033857Medicaid