Healthcare Provider Details

I. General information

NPI: 1801100284
Provider Name (Legal Business Name): DENNIS LEE SHERMAN CST/CFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 07/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 FULTON ST
PORT CLINTON OH
43452-2001
US

IV. Provider business mailing address

1201 COUNTY ROAD 157
FREMONT OH
43420-9337
US

V. Phone/Fax

Practice location:
  • Phone: 419-734-3131
  • Fax: 419-732-4062
Mailing address:
  • Phone: 419-898-0268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: