Healthcare Provider Details

I. General information

NPI: 1881084432
Provider Name (Legal Business Name): SHARLENE MARTY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/03/2015
Last Update Date: 02/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36388 DETROIT ROAD
AVON OH
44011-1588
US

IV. Provider business mailing address

36388 DETROIT ROAD
AVON OH
44011-1588
US

V. Phone/Fax

Practice location:
  • Phone: 440-934-9090
  • Fax:
Mailing address:
  • Phone: 440-934-9090
  • Fax: 440-934-9094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.020462
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: