Provider Demographics
NPI:1093021982
Name:BOUTCHER, SHERRY DAWN (RDH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DAWN
Last Name:BOUTCHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 WEMBLEY LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-4170
Mailing Address - Country:US
Mailing Address - Phone:507-280-0343
Mailing Address - Fax:
Practice Address - Street 1:903 WEST CENTER STREET SUITE 208
Practice Address - Street 2:UNITED WAY BUILDING
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55902
Practice Address - Country:US
Practice Address - Phone:507-529-0436
Practice Address - Fax:507-529-0435
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7930124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist