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General NPI Number Information
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NPI Number | 1477833572
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Entity Type | Organization
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Legal Business Name | JASON SHERMAN DDS, A DENTAL CORPORATION
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Dates
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Enumeration Date | 08/19/2011
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Last Update Date | 08/19/2011
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Provider Practice Location Address
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Address Line | 1321 S ELISEO DR
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City | GREENBRAE
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State | CA
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Zip | 94904-2024
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Country | US
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Telephone | 323-972-8076
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Fax |
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Provider Business Mailing Address
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Address Line | 1321 S ELISEO DR
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City | GREENBRAE
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State | CA
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Zip | 94904-2024
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Country | US
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Telephone | 323-972-8076
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JASON SHERMAN
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Credential | D.D.S.
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Telephone | 323-972-8076
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 55554
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License Number State | CA
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