Provider Demographics
NPI:1700958089
Name:SHER, DAVID S (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:SHER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:DAVID
Other - Middle Name:S
Other - Last Name:SHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:6258 N LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-2235
Mailing Address - Country:US
Mailing Address - Phone:773-478-5520
Mailing Address - Fax:773-478-1319
Practice Address - Street 1:6258 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-2235
Practice Address - Country:US
Practice Address - Phone:773-478-5520
Practice Address - Fax:773-478-1319
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL204440Medicare ID - Type UnspecifiedMEDICARE