Provider Demographics
NPI:1619109477
Name:CHERRY, THOMAS RAY JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAY
Last Name:CHERRY
Suffix:JR
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 1:2124 TELFAIR WAY
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-2370
Mailing Address - Country:US
Mailing Address - Phone:843-260-4405
Mailing Address - Fax:
Practice Address - Street 1:745 UNIVERSITY VILLAGE DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7613
Practice Address - Country:US
Practice Address - Phone:843-260-4405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2009-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist