Provider Demographics
NPI:1225178197
Name:GWIN, SHERRY RUTLEDGE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:RUTLEDGE
Last Name:GWIN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208
Mailing Address - Country:US
Mailing Address - Phone:601-939-7687
Mailing Address - Fax:601-939-6791
Practice Address - Street 1:181 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208
Practice Address - Country:US
Practice Address - Phone:601-939-7687
Practice Address - Fax:601-939-6791
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS234187122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS659447OtherUNITED CONCORDIA