Provider Demographics
NPI:1942308176
Name:SHERRICK, SUSAN J (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:J
Last Name:SHERRICK
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 SALEM AVE
Mailing Address - Street 2:
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-3444
Mailing Address - Country:US
Mailing Address - Phone:573-364-5530
Mailing Address - Fax:573-368-5405
Practice Address - Street 1:711 SALEM AVE
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3444
Practice Address - Country:US
Practice Address - Phone:573-364-5530
Practice Address - Fax:573-368-5405
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0157601223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics