Healthcare Provider Details

I. General information

NPI: 1316929698
Provider Name (Legal Business Name): YOWELL MICHAEL SHERRILL DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4700 LAS VEGAS BLVD N SUITE 2419
NELLIS AFB NV
89191-6600
US

IV. Provider business mailing address

2033 BOBTAIL CIR
HENDERSON NV
89012-2296
US

V. Phone/Fax

Practice location:
  • Phone: 702-653-2645
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberH-D-1-05720
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: