Provider Demographics
NPI:1649544404
Name:FISCUS, CHERIE DIANA (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERIE
Middle Name:DIANA
Last Name:FISCUS
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 1:4565 QUAIL LAKES DR
Mailing Address - Street 2:SUITE A2
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5294
Mailing Address - Country:US
Mailing Address - Phone:209-473-3990
Mailing Address - Fax:
Practice Address - Street 1:4565 QUAIL LAKES DR
Practice Address - Street 2:SUITE A2
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5294
Practice Address - Country:US
Practice Address - Phone:209-473-3990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA326001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice