Provider Demographics
NPI:1821205287
Name:CARLTON- DEAL, CHERYL L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:CARLTON- DEAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:CARLTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1625 SUNNYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-9264
Mailing Address - Country:US
Mailing Address - Phone:574-534-5528
Mailing Address - Fax:574-534-8146
Practice Address - Street 1:1625 SUNNYFIELD DR
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-9264
Practice Address - Country:US
Practice Address - Phone:574-534-5528
Practice Address - Fax:574-534-8146
Is Sole Proprietor?:No
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120101431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice