Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 9220 | CO |
NPI | 1003039579 |
---|---|
Provider Name | Holly D Sharp |
First Address | Durango, CO 81301-5010 |
Second Address | Durango, CO 81301-5010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/04/2007 |
Last Update Date | 05/08/2009 |