Healthcare Provider Details

I. General information

NPI: 1346230240
Provider Name (Legal Business Name): MARIANNE MILLS SHEROAN D.M.D, M.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 CROWNE POINTE BUSINESS CENTER SUITE F
ELIZABETHTOWN KY
42701
US

IV. Provider business mailing address

179 CAMARA CT
ELIZABETHTOWN KY
42701-5178
US

V. Phone/Fax

Practice location:
  • Phone: 270-769-3858
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number7612
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: