Provider Demographics
NPI:1891799359
Name:CHEATWOOD, GAYLE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GAYLE
Middle Name:A
Last Name:CHEATWOOD
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 1:538 HOLT AVE
Mailing Address - Street 2:
Mailing Address - City:HOLTVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92250-1216
Mailing Address - Country:US
Mailing Address - Phone:760-356-2821
Mailing Address - Fax:
Practice Address - Street 1:538 HOLT AVE
Practice Address - Street 2:
Practice Address - City:HOLTVILLE
Practice Address - State:CA
Practice Address - Zip Code:92250-1216
Practice Address - Country:US
Practice Address - Phone:760-356-2821
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist