Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 22413 | CA |
NPI | 1003250721 |
---|---|
Provider Name | Dr. Michael Jay Sherman |
First Address | Rolling Hills, CA 90274-5224 |
Second Address | Rolling Hills, CA 90274-5224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2013 |
Last Update Date | 24/04/2013 |