MEDICARE: WILLIE B. SHERMAN JR. D.D.S. P.A.

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	DN6455	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982956447
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIE B. SHERMAN JR. D.D.S. P.A.

Provider Business Mailing Address
First Line	:	3599 COLUMBIA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3419
Country	:	US
Telephone Number	:	407-295-0674
Fax Number	:	407-295-9693

Provider Business Practice Location Address
First Line	:	3599 COLUMBIA ST
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32805-3419
Country	:	US
Telephone Number	:	407-295-0674
Fax Number	:	407-295-9693

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIE B SHERMAN JR.
Credential	:	D.D.S.
Telephone Number	:	407-295-0674

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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