Provider Demographics
NPI:1114388741
Name:CHERRY DENTAL
Entity Type:Organization
Organization Name:CHERRY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:HADI
Authorized Official - Middle Name:
Authorized Official - Last Name:NOUREDINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-730-6994
Mailing Address - Street 1:11310 NE 49TH ST
Mailing Address - Street 2:#105
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-6545
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11310 NE 49TH ST
Practice Address - Street 2:#105
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98682-6545
Practice Address - Country:US
Practice Address - Phone:503-644-1110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-09
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE00007859122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty