Provider Demographics
NPI:1891352159
Name:THAMARASSERIL, SHERIN (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERIN
Middle Name:
Last Name:THAMARASSERIL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9911 NW 20TH ST
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-1443
Mailing Address - Country:US
Mailing Address - Phone:954-243-5590
Mailing Address - Fax:
Practice Address - Street 1:2310 E IRLO BRONSON MEMORIAL HWY STE C-106
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-5401
Practice Address - Country:US
Practice Address - Phone:407-935-1772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN244561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program