Active NPI
Phillip John Sheridan
- Dentist
- Peterson AFB, CO
National Provider Identifier
1760003644
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- D14402
- Practice address
- 1045 E Stewart Ave BLDG 2018
Peterson AFB, CO 80914-2900 - Phone
- (719) 556-1333
- NPI assigned
- May 1, 2020
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D14402 | MN | Primary |
Addresses
Primary practice location
1045 E Stewart Ave BLDG 2018
Peterson AFB, CO 80914-2900
Mailing address
559 Vincent St. Space Base Delta 1
Peterson Space Force Base, CO 80914
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D14402 | MN | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1588291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1766966400000",
"number": "1760003644",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "559 VINCENT ST. SPACE BASE DELTA 1",
"city": "PETERSON SPACE FORCE BASE",
"state": "CO",
"postal_code": "80914"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1045 E STEWART AVE BLDG 2018",
"city": "PETERSON AFB",
"state": "CO",
"postal_code": "809142900",
"telephone_number": "719-556-1333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHERIDAN",
"first_name": "PHILLIP",
"middle_name": "JOHN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-05-01",
"last_updated": "2025-12-29",
"certification_date": "2025-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MN",
"license": "D14402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peterson AFB, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.