Provider Demographics
NPI:1821015769
Name:SHEERIN, PETER L (DMD, INC)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:SHEERIN
Suffix:
Gender:M
Credentials:DMD, INC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1134 S ROBERTSON BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-1404
Mailing Address - Country:US
Mailing Address - Phone:310-274-6089
Mailing Address - Fax:323-272-3617
Practice Address - Street 1:1134 S ROBERTSON BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-1404
Practice Address - Country:US
Practice Address - Phone:310-274-6089
Practice Address - Fax:323-272-3617
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA302501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice