Provider Demographics
NPI:1679790745
Name:SHERIDAN, DANIEL J (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:J
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:DANIEL
Other - Middle Name:J
Other - Last Name:SHERIDAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:7827 ALEXANDRIA PIKE
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:KY
Mailing Address - Zip Code:41001-1045
Mailing Address - Country:US
Mailing Address - Phone:859-635-1756
Mailing Address - Fax:859-635-9424
Practice Address - Street 1:7827 ALEXANDRIA PIKE
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:KY
Practice Address - Zip Code:41001-1045
Practice Address - Country:US
Practice Address - Phone:859-635-1756
Practice Address - Fax:859-635-9424
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY67811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice