Provider Demographics
NPI:1295890895
Name:CHEROKEE DENTAL, P.A.
Entity type:Organization
Organization Name:CHEROKEE DENTAL, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:VANDEVELDE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:651-457-6231
Mailing Address - Street 1:374 ANNAPOLIS ST W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55118-1107
Mailing Address - Country:US
Mailing Address - Phone:651-457-6231
Mailing Address - Fax:651-457-8008
Practice Address - Street 1:374 ANNAPOLIS ST W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55118-1107
Practice Address - Country:US
Practice Address - Phone:651-457-6231
Practice Address - Fax:651-457-8008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND88011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty