MEDICARE: ANGELLA MAE SHERRILL D.M.D.

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	122300000X	Dentist	DEN03051	RI
2	122300000X	Dentist	9022	NC
3	1223D0001X	Public Health Dentistry	9022	NC
4	1223G0001X	General Practice Dentistry	9022	NC

General Provider Information

NPI Number	:	1568692382
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELLA MAE SHERRILL D.M.D.

Provider Business Mailing Address
First Line	:	908 N US HIGHWAY 421
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-0410
Country	:	US
Telephone Number	:	910-299-0991
Fax Number	:	910-299-0995

Provider Business Practice Location Address
First Line	:	908 N US HIGHWAY 421
Second Line	:
City	:	CLINTON
State	:	NC
Zip	:	28328-0410
Country	:	US
Telephone Number	:	910-299-0991
Fax Number	:	910-299-0995

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

Provider Enumeration Date	:	07/15/2009
Last Update Date	:	06/21/2013

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