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General NPI Number Information
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NPI Number | 1770600736
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Entity Type | Organization
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Legal Business Name | SHERMAN O. SMOCK DDS PC
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Dates
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Enumeration Date | 03/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 519 LEESVILLE RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2338
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Country | US
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Telephone | 434-237-2928
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Fax |
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Provider Business Mailing Address
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Address Line | 519 LEESVILLE RD
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City | LYNCHBURG
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State | VA
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Zip | 24502-2338
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Country | US
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Telephone | 434-237-2928
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Fax |
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Authorized Official
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Title or Position | PRINCIPLE SHARE HOLDER
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Name | DR. SHERMAN O. SMOCK
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Credential | DDS
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Telephone | 434-237-2928
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | VA 0005531
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License Number State | VA
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