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General NPI Number Information
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NPI Number | 1316103443
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Entity Type | Organization
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Legal Business Name | PEDIATRIC DENTISTRY OF SHERMAN, PA
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Dates
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Enumeration Date | 07/29/2008
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 2113 N LOY LAKE RD SUITE F
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City | SHERMAN
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State | TX
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Zip | 75090-2808
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Country | US
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Telephone | 903-892-2246
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Fax | 903-891-9339
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Provider Business Mailing Address
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Address Line | 2113 N LOY LAKE RD SUITE F
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City | SHERMAN
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State | TX
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Zip | 75090-2808
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Country | US
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Telephone | 903-892-2246
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Fax | 903-891-9339
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT WILLIAMSON
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Credential | DDS
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Telephone | 903-892-2246
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 23222
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License Number State | TX
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