Provider Demographics
NPI:1114151628
Name:MALINOWSKI, SHARAN AUDREY (RDH)
Entity Type:Individual
Prefix:MRS
First Name:SHARAN
Middle Name:AUDREY
Last Name:MALINOWSKI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHARAN
Other - Middle Name:AUDREY
Other - Last Name:BLAIR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 FULLER ROAD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330
Mailing Address - Country:US
Mailing Address - Phone:207-622-1711
Mailing Address - Fax:207-626-5893
Practice Address - Street 1:41 FULLER ROAD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330
Practice Address - Country:US
Practice Address - Phone:207-622-1711
Practice Address - Fax:207-626-5893
Is Sole Proprietor?:No
Enumeration Date:2009-05-12
Last Update Date:2009-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME2519124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist