Provider Demographics
NPI:1063436442
Name:SHARPE, JEFFREY L (D D S)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:L
Last Name:SHARPE
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1162 S 49TH ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-5257
Mailing Address - Country:US
Mailing Address - Phone:515-440-1224
Mailing Address - Fax:515-440-1880
Practice Address - Street 1:4150 WESTOWN PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5901
Practice Address - Country:US
Practice Address - Phone:515-440-1224
Practice Address - Fax:515-440-1880
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA77721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice