Provider Demographics
NPI:1740521244
Name:SHERIDAN DENTAL CENTER, PA
Entity type:Organization
Organization Name:SHERIDAN DENTAL CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLTON
Authorized Official - Middle Name:T
Authorized Official - Last Name:LEDING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:870-942-2822
Mailing Address - Street 1:1310 S ROCK ST STE 1
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:AR
Mailing Address - Zip Code:72150-7223
Mailing Address - Country:US
Mailing Address - Phone:870-942-2822
Mailing Address - Fax:870-615-2115
Practice Address - Street 1:1310 S ROCK ST STE 1
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:AR
Practice Address - Zip Code:72150-7223
Practice Address - Country:US
Practice Address - Phone:870-942-2822
Practice Address - Fax:870-615-2115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1124434709OtherINDIVIDUAL NPI DR. BRANDON MANN
AR1740521244Medicaid
AR1821149337OtherINDIVIDUAL NPI FOR CHAD MATONE
AR1841728235OtherINDIVIDUAL NPI FOR DR. CARLTON LEDING