Provider Demographics
NPI:1750483764
Name:CHERVENICK, MARK R (DMD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:R
Last Name:CHERVENICK
Suffix:
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:PO BOX 335
Mailing Address - Street 2:127 E MAIN ST
Mailing Address - City:BARNESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43713
Mailing Address - Country:US
Mailing Address - Phone:740-425-3045
Mailing Address - Fax:740-425-3894
Practice Address - Street 1:127 E MAIN ST
Practice Address - Street 2:
Practice Address - City:BARNESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43713
Practice Address - Country:US
Practice Address - Phone:740-425-3045
Practice Address - Fax:740-425-3894
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH193211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice