Provider Demographics
NPI:1467854356
Name:MIEHM, SHEILA O'CONNOR (RDH,MS)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:O'CONNOR
Last Name:MIEHM
Suffix:
Gender:F
Credentials:RDH,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 BABCOCK ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-1343
Mailing Address - Country:US
Mailing Address - Phone:860-695-4966
Mailing Address - Fax:
Practice Address - Street 1:176 BABCOCK ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-1343
Practice Address - Country:US
Practice Address - Phone:860-695-4966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-23
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004504124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist