Provider Demographics
NPI:1518140185
Name:CHERYL T CARRAWAY DDS
Entity Type:Organization
Organization Name:CHERYL T CARRAWAY DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKI
Authorized Official - Middle Name:W
Authorized Official - Last Name:BEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-747-2376
Mailing Address - Street 1:1117 SE 2ND ST
Mailing Address - Street 2:
Mailing Address - City:SNOW HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28580-2009
Mailing Address - Country:US
Mailing Address - Phone:252-747-2376
Mailing Address - Fax:252-747-4024
Practice Address - Street 1:1117 SE 2ND ST
Practice Address - Street 2:
Practice Address - City:SNOW HILL
Practice Address - State:NC
Practice Address - Zip Code:28580-2009
Practice Address - Country:US
Practice Address - Phone:252-747-2376
Practice Address - Fax:252-747-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5205122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89-91392Medicaid
NC91392OtherBCBS