Provider Demographics
NPI:1104313238
Name:SHERWOOD, MATTHEW BLAKE (DMD)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BLAKE
Last Name:SHERWOOD
Suffix:
Gender:M
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:PO BOX 837
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:MT
Mailing Address - Zip Code:59859-0837
Mailing Address - Country:US
Mailing Address - Phone:406-215-4705
Mailing Address - Fax:
Practice Address - Street 1:200 W RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:MT
Practice Address - Zip Code:59859-7763
Practice Address - Country:US
Practice Address - Phone:316-737-7590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-14
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MTDEN-DEN-LIC-201631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program