Healthcare Provider Details

I. General information

NPI: 1386676963
Provider Name (Legal Business Name): SHERWOOD GLENN CROW DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CHEMAWA RD NE CHEMAWA INDIAN HEALTH CENTER
SALEM OR
97305-1119
US

IV. Provider business mailing address

3750 CHEMAWA RD NE
SALEM OR
97305-1119
US

V. Phone/Fax

Practice location:
  • Phone: 503-304-7600
  • Fax: 503-304-7677
Mailing address:
  • Phone: 503-304-7631
  • Fax: 503-304-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number32052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: