Provider Demographics
NPI:1457786337
Name:CHERY, NADERGE D (DMD)
Entity Type:Individual
Prefix:
First Name:NADERGE
Middle Name:D
Last Name:CHERY
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 1:7820 BAYMEADOWS RD E
Mailing Address - Street 2:APT 511
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-4637
Mailing Address - Country:US
Mailing Address - Phone:561-271-2410
Mailing Address - Fax:
Practice Address - Street 1:445 STATE ROAD 13 STE 22
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32259-2821
Practice Address - Country:US
Practice Address - Phone:904-209-6590
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-10
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 203821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice