Healthcare Provider Details

I. General information

NPI: 1528151552
Provider Name (Legal Business Name): RONALD THOMAS SHERWOOD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N NOLAN RIVER RD
CLEBURNE TX
76033
US

IV. Provider business mailing address

800 SHADY CREEK DR
CLEBURNE TX
76033
US

V. Phone/Fax

Practice location:
  • Phone: 817-645-8906
  • Fax: 817-645-0275
Mailing address:
  • Phone: 817-641-5020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number12236
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: