Provider Demographics
NPI:1366604142
Name:SHERWOOD, STEPHEN MARSHAL (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:MARSHAL
Last Name:SHERWOOD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6500 N MOPAC EXP
Mailing Address - Street 2:SUITE 2206 BLD 2
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731
Mailing Address - Country:US
Mailing Address - Phone:512-454-6936
Mailing Address - Fax:512-454-0437
Practice Address - Street 1:6500 BALCONES DR
Practice Address - Street 2:SUITE 2206 BUILDING 2
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4342
Practice Address - Country:US
Practice Address - Phone:512-454-6936
Practice Address - Fax:512-454-0437
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX188601223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009433601Medicaid