Provider Demographics
NPI:1396952552
Name:CHERKEZ, PAULINE (DDS)
Entity type:Individual
Prefix:MS
First Name:PAULINE
Middle Name:
Last Name:CHERKEZ
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 1:520 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-1550
Mailing Address - Country:US
Mailing Address - Phone:201-488-9030
Mailing Address - Fax:201-488-9130
Practice Address - Street 1:520 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1550
Practice Address - Country:US
Practice Address - Phone:201-488-9030
Practice Address - Fax:201-488-9130
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ20418122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7942206Medicaid