Provider Demographics
NPI:1609042910
Name:SHERMAN J. MENSER D.D.S
Entity Type:Organization
Organization Name:SHERMAN J. MENSER D.D.S
Other - Org Name:SHADYBROOK COSMETIC & FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:RODGERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-737-3441
Mailing Address - Street 1:2809 SHADYBROOK DR
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-3121
Mailing Address - Country:US
Mailing Address - Phone:405-737-3441
Mailing Address - Fax:
Practice Address - Street 1:2809 SHADYBROOK DR
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-3121
Practice Address - Country:US
Practice Address - Phone:405-737-3441
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1831134295OtherTYPE I NPI