MEDICARE: DR. JASON SCOTT SHERMAN D.D.S.

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	1223G0001X	General Practice Dentistry	55554	CA

General Provider Information

NPI Number	:	1093975187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON SCOTT SHERMAN D.D.S.

Provider Business Mailing Address
First Line	:	2607 SOLANA WAY APT 7
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92651-3945
Country	:	US
Telephone Number	:	323-972-8076
Fax Number	:

Provider Business Practice Location Address
First Line	:	1260 HAMNER AVE
Second Line	:
City	:	NORCO
State	:	CA
Zip	:	92860-3136
Country	:	US
Telephone Number	:	951-279-5200
Fax Number	:

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

Provider Enumeration Date	:	06/11/2008
Last Update Date	:	06/11/2008

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