Provider Demographics
NPI:1790709905
Name:SHERIDAN, MARC WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:WILLIAM
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 N FEDERAL HWY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33460-1984
Mailing Address - Country:US
Mailing Address - Phone:561-585-8900
Mailing Address - Fax:561-585-6855
Practice Address - Street 1:1300 N FEDERAL HWY
Practice Address - Street 2:SUITE 4
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33460-1984
Practice Address - Country:US
Practice Address - Phone:561-585-8900
Practice Address - Fax:561-585-6855
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL41681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice