Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | 11050 | TN |
NPI | 1427586619 |
---|---|
Provider Name | Mary Lauren Sharp |
First Address | Decatur, AL 35601-6903 |
Second Address | Clinton, TN 37716-3143 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2017 |
Last Update Date | 01/10/2019 |