Provider Demographics
NPI:1104814052
Name:MCCREVEN, SHARON M (RDH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:M
Last Name:MCCREVEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 DOGBURN LN
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CT
Mailing Address - Zip Code:06477-3102
Mailing Address - Country:US
Mailing Address - Phone:203-867-5414
Mailing Address - Fax:203-789-5912
Practice Address - Street 1:345 DOGBURN LN
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CT
Practice Address - Zip Code:06477-3102
Practice Address - Country:US
Practice Address - Phone:203-867-5414
Practice Address - Fax:203-789-5912
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004299124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist