Mark Thomas Sherman, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11015 Issued in MN

Practice address

30957 Old Hwy 371
Pequot Lakes, MN 56472-0128

Phone

(218) 568-8295

Fax

(218) 568-4702

NPI assigned

Oct 13, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Mark T. Sherman DDS PA

  • Dental Clinic/Center
  • Pequot Lakes, MN
  • NPI 1770195158
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649360470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 128",
            "address_2": "30957 OLD HWY 371",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564720128",
            "telephone_number": "218-568-8295",
            "fax_number": "218-568-4702"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30957 OLD HWY 371",
            "city": "PEQUOT LAKES",
            "state": "MN",
            "postal_code": "564720128",
            "telephone_number": "218-568-8295",
            "fax_number": "218-568-4702"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERMAN",
        "first_name": "MARK",
        "middle_name": "THOMAS",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-10-13",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "11015",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Select Therapy, Inc.
• Select Therapy, Inc.
• Senior Class Care of Pequot Lakes, Inc.
• Senior Class Community, LLC
• Senior Class Home Health Care LLC
• Kelly A Spray, CNP
• St. Joseph'S Medical Center
• Payden Strange
• Carrie Taylor, PT
• Todd M. Wiedel, O.D., PA

• General Practice Dentistry in Pequot Lakes, MN
• Providers in Pequot Lakes, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.