MEDICARE: DR. GERALD BLAKE SHERRICK D.D.S.

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	122300000X	Dentist	0025574	TX

General Provider Information

NPI Number	:	1093036683
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GERALD BLAKE SHERRICK D.D.S.

Provider Business Mailing Address
First Line	:	1724 TRINIDAD WAY
Second Line	:
City	:	ARGYLE
State	:	TX
Zip	:	76226-1910
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2516 NE 28TH ST STE 100
Second Line	:
City	:	FT WORTH
State	:	TX
Zip	:	76106-7577
Country	:	US
Telephone Number	:	281-450-3072
Fax Number	:

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

Provider Enumeration Date	:	06/17/2010
Last Update Date	:	01/29/2018

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