Provider Demographics
NPI:1659511632
Name:PERDUE, SHERIE ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERIE
Middle Name:ANNE
Last Name:PERDUE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1145
Mailing Address - Country:US
Mailing Address - Phone:815-784-6088
Mailing Address - Fax:815-784-5199
Practice Address - Street 1:209 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1145
Practice Address - Country:US
Practice Address - Phone:815-784-6088
Practice Address - Fax:815-784-5199
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2009-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0167751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice