Healthcare Provider Details

I. General information

NPI: 1942310057
Provider Name (Legal Business Name): JOHN B SHERMAN DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 09/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3115 NORTH LESLIE ROAD
SILVER CITY NM
88061
US

IV. Provider business mailing address

3115 NORTH LESLIE ROAD
SILVER CITY NM
88061
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-2515
  • Fax: 505-388-2313
Mailing address:
  • Phone: 505-388-2515
  • Fax: 505-388-2313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD2256
License Number StateNM

VIII. Authorized Official

Name: JOHN BRIAN SHERMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 505-388-2515