Provider Demographics
NPI:1962685917
Name:SHERWOOD DENTAL CENTER PC
Entity Type:Organization
Organization Name:SHERWOOD DENTAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT SHERWOOD DENTAL CENTAL PC
Authorized Official - Prefix:DR
Authorized Official - First Name:LLOYD
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:KOEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:806-358-8561
Mailing Address - Street 1:2500 COULTER RD
Mailing Address - Street 2:101
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106
Mailing Address - Country:US
Mailing Address - Phone:806-358-8561
Mailing Address - Fax:806-358-3646
Practice Address - Street 1:2500 COULTER RD
Practice Address - Street 2:101
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106
Practice Address - Country:US
Practice Address - Phone:806-358-8561
Practice Address - Fax:806-358-3646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2012-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10969TX1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty