Provider Demographics
NPI:1629294418
Name:SHEROUSE, WESLEY ADAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:ADAM
Last Name:SHEROUSE
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 1:4790 N 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2485
Mailing Address - Country:US
Mailing Address - Phone:850-477-8524
Mailing Address - Fax:
Practice Address - Street 1:4790 N 9TH AVE
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2485
Practice Address - Country:US
Practice Address - Phone:850-477-8524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice