Provider Demographics
NPI:1013065424
Name:JOHN SHERIDAN DDS PC
Entity Type:Organization
Organization Name:JOHN SHERIDAN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHERIDAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:989-684-1520
Mailing Address - Street 1:3459 MIDLAND RD
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706
Mailing Address - Country:US
Mailing Address - Phone:989-684-1520
Mailing Address - Fax:
Practice Address - Street 1:3459 MIDLAND RD
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706
Practice Address - Country:US
Practice Address - Phone:989-684-1520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI08285MI122300000X
MI2902009588124Q00000X
MIL968360124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered122300000XDental ProvidersDentistGroup - Single Specialty
Not Answered124Q00000XDental ProvidersDental HygienistGroup - Single Specialty