Provider Demographics
NPI:1164770103
Name:DR. WILLIAM KELLEY CHERRY
Entity Type:Organization
Organization Name:DR. WILLIAM KELLEY CHERRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:KELLEY
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-842-5300
Mailing Address - Street 1:1640 SCOTTSVILLE ROAD, SUITE 300
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104
Mailing Address - Country:US
Mailing Address - Phone:270-842-5300
Mailing Address - Fax:270-842-5313
Practice Address - Street 1:1640 SCOTTSVILLE RD. SUITE 300
Practice Address - Street 2:SUITE 300
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104
Practice Address - Country:US
Practice Address - Phone:270-842-5300
Practice Address - Fax:270-842-5313
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-23
Last Update Date:2012-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty