Provider Demographics
NPI:1477663813
Name:SHERIZEN, BRUCE S (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:S
Last Name:SHERIZEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18263 FORT ST
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:MI
Mailing Address - Zip Code:48193-7434
Mailing Address - Country:US
Mailing Address - Phone:734-284-2620
Mailing Address - Fax:734-284-4290
Practice Address - Street 1:18263 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7434
Practice Address - Country:US
Practice Address - Phone:734-284-2620
Practice Address - Fax:734-284-4290
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI129601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice