Healthcare Provider Details

I. General information

NPI: 1922017243
Provider Name (Legal Business Name): CHARLES EDWARD SHERMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NW 5TH ST
GRAND RAPIDS MN
55744-2560
US

IV. Provider business mailing address

520 NW 5TH ST
GRAND RAPIDS MN
55744-2560
US

V. Phone/Fax

Practice location:
  • Phone: 218-326-2901
  • Fax: 218-327-2080
Mailing address:
  • Phone: 218-326-2901
  • Fax: 218-327-2080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8269
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: