Healthcare Provider Details

I. General information

NPI: 1225178197
Provider Name (Legal Business Name): SHERRY RUTLEDGE GWIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 09/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

181 DOCTORS DR
PEARL MS
39208
US

IV. Provider business mailing address

181 DOCTORS DR
PEARL MS
39208
US

V. Phone/Fax

Practice location:
  • Phone: 601-939-7687
  • Fax: 601-939-6791
Mailing address:
  • Phone: 601-939-7687
  • Fax: 601-939-6791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number234187
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: