Provider Demographics
NPI:1790862068
Name:SCHMIDT, CHERRYVEL MONTENEGRO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHERRYVEL
Middle Name:MONTENEGRO
Last Name:SCHMIDT
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 1:599 FARRINGTON HIGHWAY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KAPOLEI
Mailing Address - State:HI
Mailing Address - Zip Code:96707
Mailing Address - Country:US
Mailing Address - Phone:808-674-9090
Mailing Address - Fax:808-674-8399
Practice Address - Street 1:599 FARRINGTON HIGHWAY
Practice Address - Street 2:SUITE 205
Practice Address - City:KAPOLEI
Practice Address - State:HI
Practice Address - Zip Code:96707
Practice Address - Country:US
Practice Address - Phone:808-674-9090
Practice Address - Fax:808-674-8399
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIDT1917122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI191703OtherHDS
HI967539OtherU CONCORDIA
HIB212718Medicaid
HIB212718Medicaid