MEDICARE: JEFFREY SHERWOOD 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	30 - 015336	OH

General Provider Information

NPI Number	:	1770543548
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY SHERWOOD D.D.S.

Provider Business Mailing Address
First Line	:	3540 BLUE ROCK RD
Second Line	:	SUITE #8
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5107
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3540 BLUE ROCK RD
Second Line	:	SUITE #8
City	:	CINCINNATI
State	:	OH
Zip	:	45239-5107
Country	:	US
Telephone Number	:	513-741-8977
Fax Number	:

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

Provider Enumeration Date	:	03/25/2006
Last Update Date	:	07/08/2007

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