Provider Demographics
NPI:1912282757
Name:PULFER, SHERYLEEN DEREDE (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERYLEEN
Middle Name:DEREDE
Last Name:PULFER
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 1:8622 EVENTER TRL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-6564
Mailing Address - Country:US
Mailing Address - Phone:951-533-5717
Mailing Address - Fax:
Practice Address - Street 1:10215 DUPONT CIRCLE DR W
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1656
Practice Address - Country:US
Practice Address - Phone:260-489-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011741A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice