Provider Demographics
NPI:1861547754
Name:CHERRY TREE DENTAL, LLC
Entity type:Organization
Organization Name:CHERRY TREE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF HR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERICKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:608-833-4814
Mailing Address - Street 1:8025 EXCELSIOR DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717
Mailing Address - Country:US
Mailing Address - Phone:608-833-2212
Mailing Address - Fax:608-833-2215
Practice Address - Street 1:2800 WESTHILL DR
Practice Address - Street 2:S-104
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3771
Practice Address - Country:US
Practice Address - Phone:715-843-5709
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2015-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50003051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty