Provider Demographics
NPI:1356475727
Name:WEISSMAN, SHERYL K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:K
Last Name:WEISSMAN
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 1:833 SW 11TH AVE STE 514
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205-2119
Mailing Address - Country:US
Mailing Address - Phone:503-274-2222
Mailing Address - Fax:503-274-1734
Practice Address - Street 1:833 SW 11TH AVE STE 514
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-2119
Practice Address - Country:US
Practice Address - Phone:503-274-2222
Practice Address - Fax:503-274-1734
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD64621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice