Healthcare Provider Details

I. General information

NPI: 1619941143
Provider Name (Legal Business Name): KEITH H. SHERWOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 01/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 LINDALL ST SUITE 4
DANVERS MA
01923-2135
US

IV. Provider business mailing address

80 LINDALL ST SUITE 4
DANVERS MA
01923-2135
US

V. Phone/Fax

Practice location:
  • Phone: 978-777-0505
  • Fax: 978-750-4029
Mailing address:
  • Phone: 978-777-0505
  • Fax: 978-750-4029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number14573
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: