Provider Demographics
NPI:1437481959
Name:SHERIDAN DENTAL, PC
Entity Type:Organization
Organization Name:SHERIDAN DENTAL, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVOOD
Authorized Official - Middle Name:
Authorized Official - Last Name:MANSHADI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:720-470-4291
Mailing Address - Street 1:19266 E FAIR DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80016-3851
Mailing Address - Country:US
Mailing Address - Phone:720-470-4291
Mailing Address - Fax:303-766-5599
Practice Address - Street 1:5375 W 38TH AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80212-7058
Practice Address - Country:US
Practice Address - Phone:303-476-6292
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-09
Last Update Date:2010-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty