Provider Demographics
NPI:1669668190
Name:FAGO CROS, SHERI R (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERI
Middle Name:R
Last Name:FAGO CROS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71843 HIGHWAY 111
Mailing Address - Street 2:SUITE A
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-4418
Mailing Address - Country:US
Mailing Address - Phone:760-444-3202
Mailing Address - Fax:760-444-3229
Practice Address - Street 1:71843 HIGHWAY 111
Practice Address - Street 2:SUITE A
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-4418
Practice Address - Country:US
Practice Address - Phone:760-444-3202
Practice Address - Fax:760-444-3229
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58148122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist