Provider Demographics
NPI:1457705485
Name:LI, CHERYL (DMD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:LI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 PASSAIC AVE
Mailing Address - Street 2:
Mailing Address - City:EAST NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07029-1356
Mailing Address - Country:US
Mailing Address - Phone:973-704-6130
Mailing Address - Fax:
Practice Address - Street 1:191 US HIGHWAY 206 STE 11
Practice Address - Street 2:
Practice Address - City:FLANDERS
Practice Address - State:NJ
Practice Address - Zip Code:07836-9002
Practice Address - Country:US
Practice Address - Phone:973-927-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI026792001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice