Provider Demographics
NPI:1619063625
Name:SHERMAN, WILLIE B JR
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:B
Last Name:SHERMAN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3599 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805-3419
Mailing Address - Country:US
Mailing Address - Phone:407-295-0674
Mailing Address - Fax:407-295-9693
Practice Address - Street 1:3599 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-3419
Practice Address - Country:US
Practice Address - Phone:407-295-0674
Practice Address - Fax:407-295-9693
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL64551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice