Provider Demographics
NPI:1225141450
Name:CHERRY, JILL ANNETTE (DDS)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:ANNETTE
Last Name:CHERRY
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 1:1000 RIVERWALK BLVD APT 1012
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2755
Mailing Address - Country:US
Mailing Address - Phone:801-725-6365
Mailing Address - Fax:
Practice Address - Street 1:1067 TWINING ROAD
Practice Address - Street 2:
Practice Address - City:BARKSDALE AIR FORCE BASE
Practice Address - State:LA
Practice Address - Zip Code:71110
Practice Address - Country:US
Practice Address - Phone:318-456-4018
Practice Address - Fax:318-456-6636
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-3430122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist