Provider Demographics
NPI:1447746565
Name:CHERVILOV, KAMELIYA (DDS)
Entity Type:Individual
Prefix:
First Name:KAMELIYA
Middle Name:
Last Name:CHERVILOV
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 1:3621 NW 63RD ST STE C
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-2041
Mailing Address - Country:US
Mailing Address - Phone:405-848-8838
Mailing Address - Fax:405-810-0043
Practice Address - Street 1:3621 NW 63RD ST STE C
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-2041
Practice Address - Country:US
Practice Address - Phone:405-848-8838
Practice Address - Fax:405-810-0043
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK7038122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist