Provider Demographics
NPI:1134237670
Name:CHERRY CREEK DENTAL
Entity type:Organization
Organization Name:CHERRY CREEK DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MONTE
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:435-258-2301
Mailing Address - Street 1:105 S 200 W
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:UT
Mailing Address - Zip Code:84333-1278
Mailing Address - Country:US
Mailing Address - Phone:435-258-2301
Mailing Address - Fax:435-258-5521
Practice Address - Street 1:105 S 200 W
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:UT
Practice Address - Zip Code:84333-1278
Practice Address - Country:US
Practice Address - Phone:435-258-2301
Practice Address - Fax:435-258-5521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty