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General NPI Number Information
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NPI Number | 1518148238
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Entity Type | Organization
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Legal Business Name | SHERMAN AND HALLIE DDS PA
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Dates
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Enumeration Date | 11/21/2007
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Last Update Date | 11/21/2007
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Provider Practice Location Address
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Address Line | 520 5TH ST NW
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City | GRAND RAPIDS
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State | MN
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Zip | 55744
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Country | US
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Telephone | 218-326-2901
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Fax | 218-327-2080
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Provider Business Mailing Address
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Address Line | PO BOX 36 520 5TH ST NW
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City | GRAND RAPIDS
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State | MN
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Zip | 55744
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Country | US
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Telephone | 218-326-2901
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Fax | 218-327-2080
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. CHARLES E SHERMAN
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Credential | DR
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Telephone | 218-326-2901
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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 | D11926
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 8269
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License Number State | MN
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