Individual provider Active NPI

Michael Meek Sharp, DMD

  • Dentist
  • Idaho Falls, ID
National Provider Identifier
1295317097
Registry record updated Oct 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D-5512 Issued in ID
Practice address
2194 Snake River Pkwy Ste 101
Idaho Falls, ID 83402-4351
Phone
(208) 757-6245
Fax
(208) 757-6264
NPI assigned
Apr 22, 2021
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D-5512 ID Primary

Addresses

Primary practice location

2194 Snake River Pkwy Ste 101
Idaho Falls, ID 83402-4351

Mailing address

2194 Snake River Pkwy Ste 101
Idaho Falls, ID 83402-4351
Phone (208) 757-6245

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
D-5512IDMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Spring Dental Pryor PastSince Apr 1, 2021 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1619049600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730246400000",
    "number": "1295317097",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2194 SNAKE RIVER PKWY STE 101",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834024351",
            "telephone_number": "208-757-6245",
            "fax_number": "208-757-6264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2194 SNAKE RIVER PKWY STE 101",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834024351",
            "telephone_number": "208-757-6245",
            "fax_number": "208-757-6264"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHARP",
        "first_name": "MICHAEL",
        "middle_name": "MEEK",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-04-22",
        "last_updated": "2024-10-30",
        "certification_date": "2024-10-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "ID",
            "license": "D-5512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Idaho Falls, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 30, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.