Provider Demographics
NPI:1548478423
Name:CHERRY, ROBERT A (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:CHERRY
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 1:12657 NW 68TH DR
Mailing Address - Street 2:
Mailing Address - City:PARKLAND
Mailing Address - State:FL
Mailing Address - Zip Code:33076-1965
Mailing Address - Country:US
Mailing Address - Phone:954-255-0608
Mailing Address - Fax:
Practice Address - Street 1:12683 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-0907
Practice Address - Country:US
Practice Address - Phone:954-846-2222
Practice Address - Fax:954-846-2288
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00151201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice