Provider Demographics
NPI:1568957694
Name:MCSHERRY, SARAH MARIE (DMD)
Entity Type:Individual
Prefix:DR
First Name:SARAH
Middle Name:MARIE
Last Name:MCSHERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:MARIE
Other - Last Name:DETORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:23615 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-5887
Mailing Address - Country:US
Mailing Address - Phone:617-750-6652
Mailing Address - Fax:
Practice Address - Street 1:10590 ENDURING FREEDOM DR
Practice Address - Street 2:
Practice Address - City:FORT DRUM
Practice Address - State:NY
Practice Address - Zip Code:13602-5503
Practice Address - Country:US
Practice Address - Phone:315-772-5576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-01
Last Update Date:2019-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1858076122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program