Provider Demographics
NPI:1811393226
Name:SHARON DENTAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:SHARON DENTAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:COLITE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-364-0204
Mailing Address - Street 1:57 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:CT
Mailing Address - Zip Code:06069-2018
Mailing Address - Country:US
Mailing Address - Phone:860-364-0204
Mailing Address - Fax:860-364-0505
Practice Address - Street 1:57 MAIN ST
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:CT
Practice Address - Zip Code:06069-2018
Practice Address - Country:US
Practice Address - Phone:860-364-0204
Practice Address - Fax:860-364-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1962630632OtherPERSONAL NPI #