Provider Demographics
NPI:1609347657
Name:CHERRY, AIMEE RACHELLE (RDH)
Entity Type:Individual
Prefix:
First Name:AIMEE
Middle Name:RACHELLE
Last Name:CHERRY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14921 N HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:SUMMERS
Mailing Address - State:AR
Mailing Address - Zip Code:72769-9690
Mailing Address - Country:US
Mailing Address - Phone:479-790-9261
Mailing Address - Fax:
Practice Address - Street 1:SAM HIDER DENTAL CLINIC
Practice Address - Street 2:859 E MELTON DR.
Practice Address - City:JAY
Practice Address - State:OK
Practice Address - Zip Code:74346
Practice Address - Country:US
Practice Address - Phone:918-253-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4252124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist