Provider Demographics
NPI:1902909112
Name:SHERIDAN, PAUL J (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:J
Last Name:SHERIDAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17410 CINNAMON CIR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68135-3203
Mailing Address - Country:US
Mailing Address - Phone:402-614-6221
Mailing Address - Fax:
Practice Address - Street 1:14202 Y ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-2862
Practice Address - Country:US
Practice Address - Phone:402-895-2085
Practice Address - Fax:402-895-3144
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE59121223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223G0001XDental ProvidersDentistGeneral Practice
Not Answered1223P0700XDental ProvidersDentistProsthodontics