Provider Demographics
NPI:1679596936
Name:SHARKEY, EDWARD JOHN (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:JOHN
Last Name:SHARKEY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 ROGERS AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21043-4594
Mailing Address - Country:US
Mailing Address - Phone:410-465-6008
Mailing Address - Fax:410-465-5507
Practice Address - Street 1:3201 ROGERS AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-4594
Practice Address - Country:US
Practice Address - Phone:410-465-6008
Practice Address - Fax:410-465-5507
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD111951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice