MEDICARE: DR. BRUCE REED SHARPE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	4450	OK

General Provider Information

NPI Number	:	1588656326
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE REED SHARPE

Provider Business Mailing Address
First Line	:	2816 W BRITTON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4428
Country	:	US
Telephone Number	:	405-751-8000
Fax Number	:	405-751-8001

Provider Business Practice Location Address
First Line	:	2816 W BRITTON RD
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-4428
Country	:	US
Telephone Number	:	405-751-8000
Fax Number	:	405-751-8001

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2005
Last Update Date	:	07/08/2007

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