Provider Demographics
NPI:1497420269
Name:SHERIDAN, BENJAMIN (DMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:SHERIDAN
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:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:BRUSH
Mailing Address - State:CO
Mailing Address - Zip Code:80723-0563
Mailing Address - Country:US
Mailing Address - Phone:970-842-0220
Mailing Address - Fax:709-842-0224
Practice Address - Street 1:412 EDISON ST
Practice Address - Street 2:
Practice Address - City:BRUSH
Practice Address - State:CO
Practice Address - Zip Code:80723-2130
Practice Address - Country:US
Practice Address - Phone:970-842-0220
Practice Address - Fax:970-842-0224
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-12
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00204725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist