Provider Demographics
NPI:1891867479
Name:SHARRON, CANDICE DAWN (DMD)
Entity Type:Individual
Prefix:DR
First Name:CANDICE
Middle Name:DAWN
Last Name:SHARRON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9325 JAMACHA BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5042
Mailing Address - Country:US
Mailing Address - Phone:619-479-1446
Mailing Address - Fax:619-479-9970
Practice Address - Street 1:9325 JAMACHA BLVD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5042
Practice Address - Country:US
Practice Address - Phone:619-479-1446
Practice Address - Fax:619-479-9970
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADW279241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice