Provider Demographics
NPI:1598167223
Name:ANNCOLTER H CHERON DMD MS PLLC
Entity Type:Organization
Organization Name:ANNCOLTER H CHERON DMD MS PLLC
Other - Org Name:CHERON ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNCOLTER
Authorized Official - Middle Name:H
Authorized Official - Last Name:CHERON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-818-8860
Mailing Address - Street 1:6101 REDWOOD SQUARE CTR
Mailing Address - Street 2:SUITE 305
Mailing Address - City:CENTREVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20121-4265
Mailing Address - Country:US
Mailing Address - Phone:703-818-8860
Mailing Address - Fax:703-818-7632
Practice Address - Street 1:6101 REDWOOD SQUARE CTR
Practice Address - Street 2:SUITE 305
Practice Address - City:CENTREVILLE
Practice Address - State:VA
Practice Address - Zip Code:20121-4265
Practice Address - Country:US
Practice Address - Phone:703-818-8860
Practice Address - Fax:703-818-7632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-25
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014129131223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty