Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 3555 | WI |
NPI | 1215048053 |
---|---|
Provider Name | Dr. Dennis Robert Sherraden |
First Address | Monona, WI 53716-4041 |
Second Address | Monona, WI 53716-4041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
33482200 | (05) | WI |