Provider Demographics
NPI:1821613308
Name:SHERWOOD, STEPHEN BLAINE (DMD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:BLAINE
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MCCLELLAN CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CLANCY
Mailing Address - State:MT
Mailing Address - Zip Code:59634-9652
Mailing Address - Country:US
Mailing Address - Phone:316-347-4729
Mailing Address - Fax:
Practice Address - Street 1:710 S 1ST ST # 1
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MT
Practice Address - Zip Code:59840-3014
Practice Address - Country:US
Practice Address - Phone:316-347-4729
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-10
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTDEN-DEN-LIC-193281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice