Provider Demographics
NPI:1326164195
Name:THOMAS, SHERI LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:LYNN
Last Name:THOMAS
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:PO BOX 707
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-8707
Mailing Address - Country:US
Mailing Address - Phone:336-692-5260
Mailing Address - Fax:
Practice Address - Street 1:3701 S MAIN ST STE A150
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46517-3140
Practice Address - Country:US
Practice Address - Phone:574-830-8125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190229441223G0001X
NC54611223G0001X
MO20190420951223G0001X
IN12009511A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100147510Medicaid
IL9198619Medicaid
NC8998414Medicaid