Healthcare Provider Details

I. General information

NPI: 1467613380
Provider Name (Legal Business Name): KELSEY SUE SHARPE D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2008
Last Update Date: 09/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N MAIN AVE
SIOUX FALLS SD
57104-5948
US

IV. Provider business mailing address

PO BOX 90211
SIOUX FALLS SD
57109-0211
US

V. Phone/Fax

Practice location:
  • Phone: 605-367-8046
  • Fax:
Mailing address:
  • Phone: 605-212-6121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberTEMP298
License Number StateSD
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12579
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: