Provider Demographics
NPI:1003555202
Name:SHERRILL, TABITHA LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:LYNN
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1068 N COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:WESTVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46391-9436
Mailing Address - Country:US
Mailing Address - Phone:219-229-3186
Mailing Address - Fax:
Practice Address - Street 1:200 ALFRED STREET
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-3564
Practice Address - Country:US
Practice Address - Phone:219-872-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-03
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12013785A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist