Provider Demographics
NPI:1851406706
Name:CHERRY, MICHAEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:CHERRY
Suffix:
Gender:M
Credentials:DDS
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 1888
Mailing Address - Street 2:1665 WEST TEXAS AVE.
Mailing Address - City:WASKOM
Mailing Address - State:TX
Mailing Address - Zip Code:75692-1888
Mailing Address - Country:US
Mailing Address - Phone:903-687-2984
Mailing Address - Fax:903-687-2038
Practice Address - Street 1:1665 W TEXAS AVE
Practice Address - Street 2:
Practice Address - City:WASKOM
Practice Address - State:TX
Practice Address - Zip Code:75692-9652
Practice Address - Country:US
Practice Address - Phone:903-687-2984
Practice Address - Fax:903-687-2038
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX133141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
480847OtherUNITED CONCORDIA
TX13314OtherBCBS