Provider Demographics
NPI:1255562088
Name:GRISANTI, SHARON MARY (DH)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MARY
Last Name:GRISANTI
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1789 ELM ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52001-2256
Mailing Address - Country:US
Mailing Address - Phone:563-690-2850
Mailing Address - Fax:563-557-8488
Practice Address - Street 1:1789 ELM ST
Practice Address - Street 2:SUITE A
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-2256
Practice Address - Country:US
Practice Address - Phone:563-690-2850
Practice Address - Fax:563-557-8488
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1926124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist