Healthcare Provider Details

I. General information

NPI: 1124080908
Provider Name (Legal Business Name): ALAN FREDERICK SHERNOFF DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 FULTON ST
DURHAM NC
27705-3875
US

IV. Provider business mailing address

508 FULTON ST VA MEDICAL CENTER
DURHAM NC
27705-3875
US

V. Phone/Fax

Practice location:
  • Phone: 919-286-6960
  • Fax:
Mailing address:
  • Phone: 919-286-6960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number0401008071
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: