Provider Demographics
NPI:1467671198
Name:SHERMAN, RONALD GLENN (DMD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 NE 23RD CT
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-4161
Mailing Address - Country:US
Mailing Address - Phone:425-830-4103
Mailing Address - Fax:
Practice Address - Street 1:5825 221ST PL SE
Practice Address - Street 2:SUITE #100
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-8927
Practice Address - Country:US
Practice Address - Phone:425-391-4964
Practice Address - Fax:425-392-7626
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA66811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice