Provider Demographics
NPI:1417432899
Name:SHEERAN, SHELBY STEIN (DMD)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:STEIN
Last Name:SHEERAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5089 SULPHUR LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-8427
Mailing Address - Country:US
Mailing Address - Phone:270-769-8461
Mailing Address - Fax:
Practice Address - Street 1:3141 BEAUMONT CENTRE CIR STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40513-1956
Practice Address - Country:US
Practice Address - Phone:859-296-4846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY101151223G0001X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY10115OtherLICENSE NUMBER