Healthcare Provider Details

I. General information

NPI: 1770900417
Provider Name (Legal Business Name): MICHAEL D. SCHERER, DMD, MS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2014
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14570 MONO WAY SUITE #I
SONORA CA
95370-8997
US

IV. Provider business mailing address

14570 MONO WAY SUITE #I
SONORA CA
95370-8997
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-1954
  • Fax: 209-536-6554
Mailing address:
  • Phone: 209-536-1954
  • Fax: 209-536-6554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number58233
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58233
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number58232
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number58233
License Number StateCA

VIII. Authorized Official

Name: MICHAEL D SCHERER
Title or Position: PRESIDENT
Credential: DMD, MS
Phone: 209-536-1954