Provider Demographics
NPI:1154755486
Name:SHARP, ROBERT ALLEN II (DMD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:SHARP
Suffix:II
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 1:5101 GATE PKWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-7275
Mailing Address - Country:US
Mailing Address - Phone:904-998-7707
Mailing Address - Fax:904-998-7759
Practice Address - Street 1:5101 GATE PKWY
Practice Address - Street 2:SUITE 4
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-7275
Practice Address - Country:US
Practice Address - Phone:904-998-7707
Practice Address - Fax:904-998-7759
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-22
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9910122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist