Provider Demographics
NPI:1184012411
Name:PHILIPOSE, SHERLIN SARA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERLIN
Middle Name:SARA
Last Name:PHILIPOSE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHERLIN
Other - Middle Name:S
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:553 BECKETT RD
Mailing Address - Street 2:
Mailing Address - City:SWEDESBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08085-1565
Mailing Address - Country:US
Mailing Address - Phone:813-841-1134
Mailing Address - Fax:
Practice Address - Street 1:553 BECKETT RD
Practice Address - Street 2:
Practice Address - City:SWEDESBORO
Practice Address - State:NJ
Practice Address - Zip Code:08085-1565
Practice Address - Country:US
Practice Address - Phone:813-841-1134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-09
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN210151223G0001X
NJ22DI026339001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice