Provider Demographics
NPI:1487177317
Name:GILLOON, SHARON CECEIL (RDH)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:CECEIL
Last Name:GILLOON
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 W CABANA CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85202-1709
Mailing Address - Country:US
Mailing Address - Phone:480-235-6253
Mailing Address - Fax:
Practice Address - Street 1:9953 N 95TH ST STE 101
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4593
Practice Address - Country:US
Practice Address - Phone:480-998-2233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2139124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist