Provider Demographics
NPI:1104493667
Name:THOMAS, SHERNEL (DDS)
Entity type:Individual
Prefix:
First Name:SHERNEL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 THOMPSON ST
Mailing Address - Street 2:3055 MUNGER RESIDENCES
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-2414
Mailing Address - Country:US
Mailing Address - Phone:240-264-7676
Mailing Address - Fax:
Practice Address - Street 1:1525 E CHICAGO RD
Practice Address - Street 2:
Practice Address - City:STURGIS
Practice Address - State:MI
Practice Address - Zip Code:49091-1991
Practice Address - Country:US
Practice Address - Phone:269-651-7760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29016009461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice