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General NPI Number Information
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NPI Number | 1104493667
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Entity Type | Individual
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Provider Name | SHERNEL THOMAS DDS
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Gender | Female
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 06/04/2021
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Provider Practice Location Address
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Address Line | 1525 E CHICAGO RD
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City | STURGIS
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State | MI
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Zip | 49091-1991
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Country | US
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Telephone | 269-651-7760
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Fax |
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Provider Business Mailing Address
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Address Line | 540 THOMPSON ST 3055 MUNGER RESIDENCES
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City | ANN ARBOR
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State | MI
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Zip | 48104-2414
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Country | US
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Telephone | 240-264-7676
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901600946
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License Number State | MI
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