Provider Demographics
NPI:1275619405
Name:SHERIDAN, MAUREEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-4111
Mailing Address - Country:US
Mailing Address - Phone:318-868-5115
Mailing Address - Fax:318-868-5114
Practice Address - Street 1:329 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-4111
Practice Address - Country:US
Practice Address - Phone:318-868-5115
Practice Address - Fax:318-868-5114
Is Sole Proprietor?:No
Enumeration Date:2006-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA40091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice