Provider Demographics
NPI:1457430480
Name:DRS. CHERMAK AND HANSON, A N.C. GENERAL PARTNERSHIP
Entity Type:Organization
Organization Name:DRS. CHERMAK AND HANSON, A N.C. GENERAL PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHERMAK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:336-760-1491
Mailing Address - Street 1:1564 N PEACE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1328
Mailing Address - Country:US
Mailing Address - Phone:336-760-1491
Mailing Address - Fax:336-760-3944
Practice Address - Street 1:1564 N PEACE HAVEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1328
Practice Address - Country:US
Practice Address - Phone:336-760-1491
Practice Address - Fax:336-760-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7050OtherDR. DAVID CHERMAK LICENSE
NC5901582Medicaid
NC6826OtherDR. JOHN HANSON LICENSE
NC=========OtherTAX IDENTIFICATION NUMBER