MEDICARE: DR. MATTHEW SHERBAN D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	11168	TN

General Provider Information

NPI Number	:	1043574114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW SHERBAN D.M.D.

Provider Business Mailing Address
First Line	:	1021 W OAKLAND AVE STE 109
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-283-4555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1021 W OAKLAND AVE STE 109
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2192
Country	:	US
Telephone Number	:	423-283-4555
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2012
Last Update Date	:	11/20/2020

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Directions to “ DR. MATTHEW SHERBAN D.M.D.” Practice Location

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