Provider Demographics
NPI:1336159391
Name:GOLDASICH, CHERYL DIANE (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:DIANE
Last Name:GOLDASICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3610 LOMITA BLVD STE 203
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-3919
Mailing Address - Country:US
Mailing Address - Phone:310-373-9701
Mailing Address - Fax:310-373-9795
Practice Address - Street 1:3610 LOMITA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3919
Practice Address - Country:US
Practice Address - Phone:310-373-9701
Practice Address - Fax:310-373-9795
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA468051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1316559OtherUNITED CONCORDIA