Kevin Michael Sheridan, DDS

Primary specialty

Public Health DentistryTaxonomy code 1223D0001X

License

2901017315 Issued in MI

Practice address

29 Black Coal Dr
Fort Washakie, WY 82514-0128

Phone

(307) 332-7300

NPI assigned

Dec 29, 2006

Last updated

Nov 17, 2011By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321488000000",
    "number": "1861558223",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29 BLACK COAL DR",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "82514",
            "telephone_number": "307-332-7300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "29 BLACK COAL DR",
            "city": "FORT WASHAKIE",
            "state": "WY",
            "postal_code": "825140128",
            "telephone_number": "307-332-7300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERIDAN",
        "first_name": "KEVIN",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2011-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223D0001X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Public Health",
            "state": "MI",
            "license": "2901017315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Phillip Kent Rector, PHD
• Janice C Roman, R.N.
• Beth Schulte
• Amanda L Schultz, LPN
• Marilyn R. Scott, APN
• Nicholas Patrick Sheridan, DDS
• Shoshone & Arapaho Tribal Substance Abuse Court
• Shoshone Tribe (Wind River Dialysis Center)
• Shoshone Tribe
• Shoshone Tribe Early Intervention Program

• Public Health Dentistry in Fort Washakie, WY
• Providers in Fort Washakie, WY by specialty
• Public Health Dentistry in Wyoming

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.