Provider Demographics
NPI:1619941143
Name:SHERWOOD, KEITH H (DDS)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:H
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 LINDALL ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-2135
Mailing Address - Country:US
Mailing Address - Phone:978-777-0505
Mailing Address - Fax:978-750-4029
Practice Address - Street 1:80 LINDALL ST
Practice Address - Street 2:SUITE 4
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-2135
Practice Address - Country:US
Practice Address - Phone:978-777-0505
Practice Address - Fax:978-750-4029
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-13
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA145731223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAAA8115OtherHARVARD PILGRIM
MAX08855OtherBLUE CROSS DENTAL
MAX08885OtherBLUE CROSS
MA000161OtherTUFTS HEALTH PLAN
MA14573OtherDELTA DENTAL
MA8916540OtherCIGNA
MA0032050OtherNEIGHBORHOOD HEALTH PLAN
MAX08855OtherBLUE CROSS DENTAL