Provider Demographics
NPI:1225615156
Name:CHERRY ORCHARD PEDIATRIC DENTISTRY, LLC
Entity Type:Organization
Organization Name:CHERRY ORCHARD PEDIATRIC DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:864-603-2603
Mailing Address - Street 1:106 SHAMROCK LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-5462
Mailing Address - Country:US
Mailing Address - Phone:864-423-4129
Mailing Address - Fax:
Practice Address - Street 1:101 HALTON RD STE B
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-3507
Practice Address - Country:US
Practice Address - Phone:864-603-2603
Practice Address - Fax:864-603-2606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-26
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty