Provider Demographics
NPI:1962596197
Name:S. C. CHEESMAN D.D.S. P.C.
Entity type:Organization
Organization Name:S. C. CHEESMAN D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SKIPPER
Authorized Official - Middle Name:CURTIS
Authorized Official - Last Name:CHEESMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:317-831-4240
Mailing Address - Street 1:150 N INDIANA ST
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46158-1506
Mailing Address - Country:US
Mailing Address - Phone:317-831-4240
Mailing Address - Fax:317-831-4473
Practice Address - Street 1:150 N INDIANA ST
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46158-1506
Practice Address - Country:US
Practice Address - Phone:317-831-4240
Practice Address - Fax:317-831-4473
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009459122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty