Healthcare Provider Details

I. General information

NPI: 1174644132
Provider Name (Legal Business Name): VIRGINIA LEE SHARPE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 05/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 CALLE MEDICO SUITE 2
SANTA FE NM
87505-4761
US

IV. Provider business mailing address

6 CALLE MEDICO SUITE 2
SANTA FE NM
87505-4761
US

V. Phone/Fax

Practice location:
  • Phone: 505-982-4686
  • Fax: 505-989-8266
Mailing address:
  • Phone: 505-982-4686
  • Fax: 505-989-8266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD4228
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE2558
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: