Provider Demographics
NPI:1134370364
Name:CHERNIK, JERRY WILLIAM (DMD)
Entity type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WILLIAM
Last Name:CHERNIK
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 1:950 BOGARD RD.
Mailing Address - Street 2:SUITE #225
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654
Mailing Address - Country:US
Mailing Address - Phone:907-376-0600
Mailing Address - Fax:907-373-0745
Practice Address - Street 1:950 BOGARD RD.
Practice Address - Street 2:SUITE #225
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654
Practice Address - Country:US
Practice Address - Phone:907-376-0600
Practice Address - Fax:907-373-0745
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA#644122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist