Provider Demographics
NPI:1700294683
Name:EFRON, SHARON G (RDH, BS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:EFRON
Suffix:
Gender:F
Credentials:RDH, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 PHEASANT HILL DR
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-3328
Mailing Address - Country:US
Mailing Address - Phone:860-559-4010
Mailing Address - Fax:
Practice Address - Street 1:1050 SULLIVAN AVE
Practice Address - Street 2:
Practice Address - City:SOUTH WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06074-2000
Practice Address - Country:US
Practice Address - Phone:860-644-2476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3262124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT$$$$$$$$$Medicaid