Provider Demographics
NPI:1033133749
Name:SHEREN, KEVIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:SHEREN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:182 W MONTAUK HWY
Mailing Address - Street 2:BUILDING B SUITE E
Mailing Address - City:HAMPTON BAYS
Mailing Address - State:NY
Mailing Address - Zip Code:11946-2345
Mailing Address - Country:US
Mailing Address - Phone:631-728-8400
Mailing Address - Fax:631-728-8482
Practice Address - Street 1:182 W MONTAUK HWY
Practice Address - Street 2:BUILDING B SUITE E
Practice Address - City:HAMPTON BAYS
Practice Address - State:NY
Practice Address - Zip Code:11946-2345
Practice Address - Country:US
Practice Address - Phone:631-728-8400
Practice Address - Fax:631-728-8482
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046780-11223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice