Healthcare Provider Details

I. General information

NPI: 1568692382
Provider Name (Legal Business Name): ANGELLA MAE SHERRILL D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 N US HIGHWAY 421
CLINTON NC
28328-0410
US

IV. Provider business mailing address

908 N US HIGHWAY 421
CLINTON NC
28328-0410
US

V. Phone/Fax

Practice location:
  • Phone: 910-299-0991
  • Fax: 910-299-0995
Mailing address:
  • Phone: 910-299-0991
  • Fax: 910-299-0995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDEN03051
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9022
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number9022
License Number StateNC
# 4
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number9022
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: