Healthcare Provider Details

I. General information

NPI: 1326242512
Provider Name (Legal Business Name): EDWARD CHARLES SHARP D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2007
Last Update Date: 07/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46900 MONROE ST
INDIO CA
92201-4827
US

IV. Provider business mailing address

80533 CAMINO SANTA JULIANA
INDIO CA
92203-7502
US

V. Phone/Fax

Practice location:
  • Phone: 760-396-5733
  • Fax:
Mailing address:
  • Phone: 760-297-2110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number18408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: