Organization
MARK T. SHERMAN DDS PA
Active
Other names
Pequot Lakes Dental Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARK T SHERMAN DDS (OWNER)
(218) 568-8295
Entity
Organization
Contact information
Practice address
31011 RASMUSSEN RD, PEQUOT LAKES, MN 56472-1227
(218) 568-8295
Mailing address
PO BOX 128, PEQUOT LAKES, MN 56472-0128
(218) 568-8295
(218) 568-4702
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D11015
BOARD LICENSE
MN
Enumeration date
08/18/2020
Last updated
08/18/2020
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