MEDICARE: DR. CYNTHIA E SHERWOOD

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	5843	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	08364	OTHER	KS	BC/BS

General Provider Information

NPI Number	:	1235134206
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA E SHERWOOD

Provider Business Mailing Address
First Line	:	PO BOX 964
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-0964
Country	:	US
Telephone Number	:	620-331-4499
Fax Number	:	620-331-4592

Provider Business Practice Location Address
First Line	:	308 N 6TH ST
Second Line	:
City	:	INDEPENDENCE
State	:	KS
Zip	:	67301-3129
Country	:	US
Telephone Number	:	620-331-4499
Fax Number	:	620-331-4592

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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