Healthcare Provider Details

I. General information

NPI: 1144323932
Provider Name (Legal Business Name): BERYL R SHERMAN DDS ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 ZIMMERMAN RD
LEOLA PA
17540-1949
US

IV. Provider business mailing address

1211 VALLEY ROAD
LANCASTER PA
17603-2506
US

V. Phone/Fax

Practice location:
  • Phone: 717-656-3206
  • Fax: 717-392-0385
Mailing address:
  • Phone: 717-392-6092
  • Fax: 713-392-0385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberDS013078L
License Number StatePA

VIII. Authorized Official

Name: DR. BERYL R SHERMAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 717-392-6092