1619941143 NPI number — KEITH H. SHERWOOD DDS

Table of content: MS. SUSAN MARIE DUTTON M.N.S. CCC-SLP (NPI 1467534016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619941143 NPI number — KEITH H. SHERWOOD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHERWOOD
Provider First Name:
KEITH
Provider Middle Name:
H.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1619941143
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 LINDALL ST
Provider Second Line Business Mailing Address:
SUITE 4
Provider Business Mailing Address City Name:
DANVERS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01923-2135
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-777-0505
Provider Business Mailing Address Fax Number:
978-750-4029

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 LINDALL ST
Provider Second Line Business Practice Location Address:
SUITE 4
Provider Business Practice Location Address City Name:
DANVERS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01923-2135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-777-0505
Provider Business Practice Location Address Fax Number:
978-750-4029
Provider Enumeration Date:
02/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , with the licence number:  14573 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: AA8115 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: X08855 . This is a "BLUE CROSS DENTAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: X08885 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000161 . This is a "TUFTS HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 14573 . This is a "DELTA DENTAL" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 8916540 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0032050 . This is a "NEIGHBORHOOD HEALTH PLAN" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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