Provider Demographics
NPI:1952442899
Name:MIYAMOTO, SHARON A (DDS)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:A
Last Name:MIYAMOTO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:MIYAMOTO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:3500 LOMITA BLVD
Mailing Address - Street 2:#103
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5021
Mailing Address - Country:US
Mailing Address - Phone:310-530-7011
Mailing Address - Fax:
Practice Address - Street 1:3500 LOMITA BLVD
Practice Address - Street 2:#103
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5021
Practice Address - Country:US
Practice Address - Phone:310-530-7011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA361781223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA680505709OtherTIN