Provider Demographics
NPI:1750167003
Name:CHEEVER, SHARONDA LACRETIA CAROL (DDS)
Entity type:Individual
Prefix:DR
First Name:SHARONDA
Middle Name:LACRETIA CAROL
Last Name:CHEEVER
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 1:5 LAUREL RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:PORT WENTWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-3629
Mailing Address - Country:US
Mailing Address - Phone:912-337-3966
Mailing Address - Fax:
Practice Address - Street 1:745 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313-4614
Practice Address - Country:US
Practice Address - Phone:912-876-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-04
Last Update Date:2023-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN123249122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist