Provider Demographics
NPI:1497080022
Name:SELINGA-REWENKO, SHARON LYNN (DMD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LYNN
Last Name:SELINGA-REWENKO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MRS
Other - First Name:SHARON
Other - Middle Name:LYNN
Other - Last Name:REWENKO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 MELROSE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06032
Mailing Address - Country:US
Mailing Address - Phone:860-677-1316
Mailing Address - Fax:860-677-4537
Practice Address - Street 1:5 MELROSE DRIVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:CT
Practice Address - Zip Code:06032
Practice Address - Country:US
Practice Address - Phone:860-677-1316
Practice Address - Fax:860-677-4537
Is Sole Proprietor?:No
Enumeration Date:2009-10-15
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008347122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist