Healthcare Provider Details

I. General information

NPI: 1053330928
Provider Name (Legal Business Name): GENE H SHERMAN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 STONEGATE RD
ALGONQUIN IL
60102-5614
US

IV. Provider business mailing address

275 STONEGATE RD
ALGONQUIN IL
60102-5614
US

V. Phone/Fax

Practice location:
  • Phone: 847-764-3600
  • Fax: 847-483-1463
Mailing address:
  • Phone: 847-764-3600
  • Fax: 847-483-1463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number019017893
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number019017893
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: