MEDICARE: DR. ROBERT DAVID SHERIDAN DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DN16850	FL

General Provider Information

NPI Number	:	1821214149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DAVID SHERIDAN DDS

Provider Business Mailing Address
First Line	:	17020 COUNTY LINE RD
Second Line	:	SUITE 102
City	:	SPRING HILL
State	:	FL
Zip	:	34610-7009
Country	:	US
Telephone Number	:	352-593-4997
Fax Number	:	352-593-5805

Provider Business Practice Location Address
First Line	:	17020 COUNTY LINE RD
Second Line	:	SUITE 102
City	:	SPRING HILL
State	:	FL
Zip	:	34610-7009
Country	:	US
Telephone Number	:	352-593-4997
Fax Number	:	352-593-5805

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	12/30/2011

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