Healthcare Provider Details

I. General information

NPI: 1134280068
Provider Name (Legal Business Name): SHERWOOD DONALD BRYAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 WEST THIRD STREET
PROPHETSTOWN IL
61277
US

IV. Provider business mailing address

108 WEST THIRD STREET
PROPHETSTOWN IL
61277
US

V. Phone/Fax

Practice location:
  • Phone: 815-537-5410
  • Fax:
Mailing address:
  • Phone: 815-537-5410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: