Provider Demographics
NPI:1073674941
Name:POWELL, SHERRY R (DMD)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:R
Last Name:POWELL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 MIDLANDS CT
Mailing Address - Street 2:
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3456
Mailing Address - Country:US
Mailing Address - Phone:803-739-0390
Mailing Address - Fax:803-926-9041
Practice Address - Street 1:120 MIDLANDS CT
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3456
Practice Address - Country:US
Practice Address - Phone:803-739-0390
Practice Address - Fax:803-926-9041
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC31841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice