Provider Demographics
NPI:1861757098
Name:SHARP, RYAN BURR (DDS)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:BURR
Last Name:SHARP
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1166 SOPHIA ST
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-4930
Mailing Address - Country:US
Mailing Address - Phone:972-998-6235
Mailing Address - Fax:
Practice Address - Street 1:440 STATE HIGHWAY 78 STE 200
Practice Address - Street 2:
Practice Address - City:LAVON
Practice Address - State:TX
Practice Address - Zip Code:75166-1266
Practice Address - Country:US
Practice Address - Phone:972-853-2100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX280361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice