MEDICARE: DR. HAROLD PETER SHERMAN 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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	030775	NY

General Provider Information

NPI Number	:	1386996981
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HAROLD PETER SHERMAN D.M.D.

Provider Business Mailing Address
First Line	:	12 BOND ST
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2005
Country	:	US
Telephone Number	:	516-487-0660
Fax Number	:	516-487-6924

Provider Business Practice Location Address
First Line	:	12 BOND ST
Second Line	:
City	:	GREAT NECK
State	:	NY
Zip	:	11021-2005
Country	:	US
Telephone Number	:	516-487-0660
Fax Number	:	516-487-6924

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

Provider Enumeration Date	:	10/05/2012
Last Update Date	:	10/05/2012

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