Healthcare Provider Details

I. General information

NPI: 1366058604
Provider Name (Legal Business Name): SHERWOOD ORAL SURGERY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

174B EXECUTIVE DR
DANVILLE VA
24541-4100
US

IV. Provider business mailing address

174B EXECUTIVE DR
DANVILLE VA
24541-4100
US

V. Phone/Fax

Practice location:
  • Phone: 434-792-4046
  • Fax: 434-792-7200
Mailing address:
  • Phone: 434-792-4046
  • Fax: 434-792-7200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: TAMMY C MCVAY
Title or Position: OFFICE ASSISTANT
Credential:
Phone: 434-792-4046