Provider Demographics
NPI:1437372950
Name:SHERLOCK, KATHLEEN A (DMD)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:A
Last Name:SHERLOCK
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 1:717 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:SD
Mailing Address - Zip Code:57006-1426
Mailing Address - Country:US
Mailing Address - Phone:605-692-4715
Mailing Address - Fax:605-692-2427
Practice Address - Street 1:717 MAIN AVE
Practice Address - Street 2:
Practice Address - City:BROOKINGS
Practice Address - State:SD
Practice Address - Zip Code:57006-1426
Practice Address - Country:US
Practice Address - Phone:605-692-4715
Practice Address - Fax:605-692-2427
Is Sole Proprietor?:No
Enumeration Date:2007-04-11
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM8591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice