Provider Demographics
NPI:1649059288
Name:KIDD, CHERYLL ANN (RDH, RDHAP)
Entity type:Individual
Prefix:
First Name:CHERYLL
Middle Name:ANN
Last Name:KIDD
Suffix:
Gender:F
Credentials:RDH, RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9730 HURON ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5219
Mailing Address - Country:US
Mailing Address - Phone:619-782-1285
Mailing Address - Fax:
Practice Address - Street 1:9730 HURON ST
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-5219
Practice Address - Country:US
Practice Address - Phone:619-782-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-25
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1003124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist