MEDICARE: SHERMAN ELY 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	1223G0001X	General Practice Dentistry	4206	WA

General Provider Information

NPI Number	:	1184785735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERMAN ELY D.D.S.

Provider Business Mailing Address
First Line	:	410 BELLEVUE WAY SE STE 102
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6649
Country	:	US
Telephone Number	:	425-454-3833
Fax Number	:	425-635-9312

Provider Business Practice Location Address
First Line	:	410 BELLEVUE WAY SE STE 102
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-6649
Country	:	US
Telephone Number	:	425-454-3833
Fax Number	:	425-635-9312

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

Provider Enumeration Date	:	12/13/2006
Last Update Date	:	07/08/2007

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Directions to “ SHERMAN ELY D.D.S.” Practice Location

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