Provider Demographics
NPI:1811540693
Name:CHERRY VALLEY SMILES, INC.
Entity Type:Organization
Organization Name:CHERRY VALLEY SMILES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:W
Authorized Official - Last Name:OGBURN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-986-1974
Mailing Address - Street 1:PO BOX 227
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:PA
Mailing Address - Zip Code:15340-0227
Mailing Address - Country:US
Mailing Address - Phone:724-986-1974
Mailing Address - Fax:
Practice Address - Street 1:101 N MCDONALD ST
Practice Address - Street 2:
Practice Address - City:MC DONALD
Practice Address - State:PA
Practice Address - Zip Code:15057-1200
Practice Address - Country:US
Practice Address - Phone:724-926-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-19
Last Update Date:2019-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031268130002Medicaid