Provider Demographics
NPI:1962640755
Name:STILES, CHERYL L (RDH, CPDH)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:STILES
Suffix:
Gender:F
Credentials:RDH, CPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 LA COLONIA ST
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-2901
Mailing Address - Country:US
Mailing Address - Phone:575-642-4133
Mailing Address - Fax:
Practice Address - Street 1:335 LA COLONIA ST
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-2901
Practice Address - Country:US
Practice Address - Phone:575-642-4133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-02
Last Update Date:2009-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1321124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist