Provider Demographics
NPI:1861659963
Name:DENNIS R SHERRADEN, DDS, LLC
Entity Type:Organization
Organization Name:DENNIS R SHERRADEN, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:SHERRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-221-8787
Mailing Address - Street 1:100 RIVER PL
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MONONA
Mailing Address - State:WI
Mailing Address - Zip Code:53716-4041
Mailing Address - Country:US
Mailing Address - Phone:608-221-8787
Mailing Address - Fax:608-441-9157
Practice Address - Street 1:100 RIVER PL
Practice Address - Street 2:SUITE 189
Practice Address - City:MONONA
Practice Address - State:WI
Practice Address - Zip Code:53716-4041
Practice Address - Country:US
Practice Address - Phone:608-221-8787
Practice Address - Fax:608-441-9157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-18
Last Update Date:2008-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WIWI 3555261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33482200Medicaid
WID37143Medicare PIN