Provider Demographics
NPI:1770600736
Name:SHERMAN O. SMOCK DDS PC
Entity type:Organization
Organization Name:SHERMAN O. SMOCK DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPLE SHARE HOLDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:O
Authorized Official - Last Name:SMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:434-237-2928
Mailing Address - Street 1:519 LEESVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24502-2338
Mailing Address - Country:US
Mailing Address - Phone:434-237-2928
Mailing Address - Fax:
Practice Address - Street 1:519 LEESVILLE RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24502-2338
Practice Address - Country:US
Practice Address - Phone:434-237-2928
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAVA 00055311223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty