Provider Demographics
NPI:1356420467
Name:CHERMAK, DAVID S (DMD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:CHERMAK
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 1:1564 N PEACE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-1328
Mailing Address - Country:US
Mailing Address - Phone:336-760-1491
Mailing Address - Fax:336-760-3944
Practice Address - Street 1:1564 N PEACE HAVEN RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27104-1328
Practice Address - Country:US
Practice Address - Phone:336-760-1491
Practice Address - Fax:336-760-3944
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70501223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7050OtherDENTAL LICENSE