Provider Demographics
NPI:1114051273
Name:SHERRY, JEFFREY SCOTT (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:SCOTT
Last Name:SHERRY
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 HIGHWAY 5
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DOUGLASVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30135-6935
Mailing Address - Country:US
Mailing Address - Phone:770-949-7753
Mailing Address - Fax:770-949-1783
Practice Address - Street 1:3655 HIGHWAY 5
Practice Address - Street 2:SUITE 102
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-6935
Practice Address - Country:US
Practice Address - Phone:770-949-7753
Practice Address - Fax:770-949-1783
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0099741223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics