Provider Demographics
NPI:1700172129
Name:CHERY, JERRY (DDS)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:CHERY
Suffix:
Gender:M
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:PO BOX 997
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34220-0997
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:941-776-4013
Practice Address - Street 1:1515 26TH AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34208-7707
Practice Address - Country:US
Practice Address - Phone:941-708-7607
Practice Address - Fax:941-708-7618
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN19659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist