Provider Demographics
NPI:1407295082
Name:CEREMUGA, CHAD E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
Last Name:CEREMUGA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 COZY OAK AVE
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8865
Mailing Address - Country:US
Mailing Address - Phone:919-457-2411
Mailing Address - Fax:
Practice Address - Street 1:1801 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHAPEL HILL
Practice Address - State:NC
Practice Address - Zip Code:27514-5855
Practice Address - Country:US
Practice Address - Phone:919-929-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9548122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist