Provider Demographics
NPI:1497471148
Name:DANIEL SHERIDAN DDS
Entity Type:Organization
Organization Name:DANIEL SHERIDAN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:YVONNE
Authorized Official - Middle Name:
Authorized Official - Last Name:DE LA CRUZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-792-1900
Mailing Address - Street 1:138 HARROW LN STE 1
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-6061
Mailing Address - Country:US
Mailing Address - Phone:989-792-1900
Mailing Address - Fax:
Practice Address - Street 1:138 HARROW LN STE 1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-6061
Practice Address - Country:US
Practice Address - Phone:989-792-1900
Practice Address - Fax:989-792-0044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-14
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1518997006Medicaid