Provider Demographics
NPI:1134107410
Name:CHERRY, JAMES
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:CHERRY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S BRADY ST
Mailing Address - Street 2:STE. 321
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-2133
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3 S BRADY ST
Practice Address - Street 2:STE. 321
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-2133
Practice Address - Country:US
Practice Address - Phone:814-371-3452
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS192071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice