Provider Demographics
NPI:1679586523
Name:GWILLIAM, SHARON WARDY (RDH)
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:WARDY
Last Name:GWILLIAM
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:W
Other - Last Name:BELMONT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13726 SE ELLS CT
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6503
Mailing Address - Country:US
Mailing Address - Phone:503-442-5767
Mailing Address - Fax:
Practice Address - Street 1:1314 NE GRAND AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1127
Practice Address - Country:US
Practice Address - Phone:503-280-2877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2018-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5056124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist