Healthcare Provider Details

I. General information

NPI: 1538225834
Provider Name (Legal Business Name): DALE STANLEY SHARPLES II DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W 12TH AVE
COLUMBUS OH
43210-1267
US

IV. Provider business mailing address

10100 HOUNSDALE DR
PICKERINGTON OH
43147-8460
US

V. Phone/Fax

Practice location:
  • Phone: 614-292-1472
  • Fax: 614-292-8013
Mailing address:
  • Phone: 614-688-5808
  • Fax: 614-292-8013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30-01-7414
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: