Provider Demographics
NPI:1922011592
Name:SHERIDAN, LINDA DIANE (DDS)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:DIANE
Last Name:SHERIDAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 SOUTH AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95949
Mailing Address - Country:US
Mailing Address - Phone:530-272-2373
Mailing Address - Fax:530-272-2377
Practice Address - Street 1:262 S AUBURN ST STE A
Practice Address - Street 2:
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-7220
Practice Address - Country:US
Practice Address - Phone:530-272-9661
Practice Address - Fax:530-273-4734
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA284891223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics