Eddy Waller Sherman, DDS
Individual provider Active NPI Dentist · Summerfield, LA
NPI 1003988239 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1003988239
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- LA2472 (LA)
- Practice address
- 723 Horsehoe Rd
Summerfield, LA 71079 - Phone
- (318) 927-2522
- NPI assigned
- Nov 14, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LA2472 | LA | MD | Dentist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | LA2472 | LA | Yes |
Addresses
Primary practice location
723 Horsehoe Rd
Summerfield, LA 71079
Mailing address
PO Box 191
Summerfield, LA 71079
Phone (318) 927-2522
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1824721 | Medicaid | LA |
Other providers in Summerfield, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.