=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336783026
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEMECULA VALLEY MICRO ENDODONTICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2019
-----------------------------------------------------
Last Update Date | 11/05/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 39755 DATE ST
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2007
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-677-0826
-----------------------------------------------------
Fax | 951-677-0827
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 39755 DATE ST STE 208
-----------------------------------------------------
City | MURRIETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92563-2008
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 951-677-0826
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL GEOFFREY SHERMAN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 617-290-1952
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223E0200X
-----------------------------------------------------
Taxonomy Name | Endodontics
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------