Provider Demographics
NPI:1275544975
Name:CHEREWKA, MARK G (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:CHEREWKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N ENOLA RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-2129
Mailing Address - Country:US
Mailing Address - Phone:717-732-2550
Mailing Address - Fax:717-732-2275
Practice Address - Street 1:525 N ENOLA RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-2129
Practice Address - Country:US
Practice Address - Phone:717-732-2550
Practice Address - Fax:717-732-2275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS-025505-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice