Healthcare Provider Details

I. General information

NPI: 1962685917
Provider Name (Legal Business Name): SHERWOOD DENTAL CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 02/22/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 COULTER RD 101
AMARILLO TX
79106
US

IV. Provider business mailing address

2500 COULTER RD 101
AMARILLO TX
79106
US

V. Phone/Fax

Practice location:
  • Phone: 806-358-8561
  • Fax: 806-358-3646
Mailing address:
  • Phone: 806-358-8561
  • Fax: 806-358-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number10969TX
License Number StateTX

VIII. Authorized Official

Name: DR. LLOYD DEAN KOEN
Title or Position: PRESIDENT SHERWOOD DENTAL CENTAL PC
Credential: DDS
Phone: 806-358-8561