Provider Demographics
NPI:1518969492
Name:ANCRUM, CHERYL DENISE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:DENISE
Last Name:ANCRUM
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 1:230 HILTON AVE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11550-8115
Mailing Address - Country:US
Mailing Address - Phone:516-483-8375
Mailing Address - Fax:516-483-8375
Practice Address - Street 1:230 HILTON AVE
Practice Address - Street 2:SUITE 203
Practice Address - City:HEMPSTEAD
Practice Address - State:NY
Practice Address - Zip Code:11550-8115
Practice Address - Country:US
Practice Address - Phone:516-483-8375
Practice Address - Fax:516-483-8375
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-11
Last Update Date:2016-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0408071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01264153Medicaid