Provider Demographics
NPI:1831296045
Name:GREGORY E. CHESHIRE, DMD, PA
Entity Type:Organization
Organization Name:GREGORY E. CHESHIRE, DMD, PA
Other - Org Name:CHESHIRE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:CHESHIRE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:321-794-9367
Mailing Address - Street 1:3200 SOUTHERN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32952-4155
Mailing Address - Country:US
Mailing Address - Phone:321-794-9367
Mailing Address - Fax:
Practice Address - Street 1:1565 SARNO RD
Practice Address - Street 2:SUITE C
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5268
Practice Address - Country:US
Practice Address - Phone:321-600-4994
Practice Address - Fax:321-600-4929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2011-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN140211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty