Provider Demographics
NPI:1477627206
Name:STEPHEN M SHERWOOD DDS PLLC
Entity Type:Organization
Organization Name:STEPHEN M SHERWOOD DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARSHALL
Authorized Official - Last Name:SHERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-6936
Mailing Address - Street 1:6500 N MOPAC
Mailing Address - Street 2:BLDG 2 SUITE 2206
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-454-6936
Mailing Address - Fax:512-454-0437
Practice Address - Street 1:6500 N MOPAC
Practice Address - Street 2:BLDG 2 SUITE 2206
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-454-6936
Practice Address - Fax:512-454-0437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009433601Medicaid
TXB722OtherBC/BS
TX009433601Medicaid