Provider Demographics
NPI:1669217204
Name:CHERBAKA, PATRICK (DMD)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:CHERBAKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5655 MAUNA LOA BLVD UNIT 210
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34240-7079
Mailing Address - Country:US
Mailing Address - Phone:201-452-6077
Mailing Address - Fax:
Practice Address - Street 1:379 KINGS HWY UNIT 300
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33983-5261
Practice Address - Country:US
Practice Address - Phone:941-467-3321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-26
Last Update Date:2024-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL292181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice