Provider Demographics
NPI:1598009169
Name:BRUBAKER, CHERI LYNN
Entity Type:Individual
Prefix:MRS
First Name:CHERI
Middle Name:LYNN
Last Name:BRUBAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MANOR OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17551-9503
Mailing Address - Country:US
Mailing Address - Phone:717-799-8138
Mailing Address - Fax:
Practice Address - Street 1:21 MANOR OAKS DR
Practice Address - Street 2:
Practice Address - City:MILLERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17551-9503
Practice Address - Country:US
Practice Address - Phone:717-799-8138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA92174214124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist