Provider Demographics
NPI:1689053845
Name:SHERIDAN DENTAL CENTER, LLC
Entity Type:Organization
Organization Name:SHERIDAN DENTAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:LEON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-981-4107
Mailing Address - Street 1:5351 SHERIDAN ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-3342
Mailing Address - Country:US
Mailing Address - Phone:954-981-4107
Mailing Address - Fax:954-981-2163
Practice Address - Street 1:5351 SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-3342
Practice Address - Country:US
Practice Address - Phone:954-981-4107
Practice Address - Fax:954-981-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-21
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00122381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty