MEDICARE: DOSA PLANO, LLC

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)	22076	TX

General Provider Information

NPI Number	:	1053552208
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOSA PLANO, LLC

Provider Business Mailing Address
First Line	:	5824 W PLANO PKWY
Second Line	:	STE 101
City	:	PLANO
State	:	TX
Zip	:	75093-4630
Country	:	US
Telephone Number	:	972-267-3223
Fax Number	:	972-733-0567

Provider Business Practice Location Address
First Line	:	5824 W PLANO PKWY
Second Line	:	STE 101
City	:	PLANO
State	:	TX
Zip	:	75093-4630
Country	:	US
Telephone Number	:	972-267-3223
Fax Number	:	972-733-0567

Authorized Official
Title or Position	:	SOLE MEMBER/OWNER
Name	:	DR. STEVEN D SHERRY
Credential	:	DDS, MD
Telephone Number	:	214-392-8115

Provider Enumeration Date	:	03/18/2009
Last Update Date	:	03/18/2009

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