Provider Demographics
NPI:1578789533
Name:CHERRY, WILLIAM KELLEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:KELLEY
Last Name:CHERRY
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 1:1878 RICHPOND RD
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42104-8724
Mailing Address - Country:US
Mailing Address - Phone:270-796-3738
Mailing Address - Fax:
Practice Address - Street 1:1640 SCOTTSVILLE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42104-3245
Practice Address - Country:US
Practice Address - Phone:270-796-3738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2009-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY76461223G0001X, 1223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No1223D0001XDental ProvidersDentistDental Public Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60000502Medicaid