Provider Demographics
NPI:1861589152
Name:ANDERSON CERMIN, CHERYL KAY (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:KAY
Last Name:ANDERSON CERMIN
Suffix:
Gender:F
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:PO BOX 887
Mailing Address - Street 2:307 N WASHINGTON
Mailing Address - City:ST CROIX FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54024
Mailing Address - Country:US
Mailing Address - Phone:715-483-1505
Mailing Address - Fax:715-483-9962
Practice Address - Street 1:307 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ST CROIX FALLS
Practice Address - State:WI
Practice Address - Zip Code:54024
Practice Address - Country:US
Practice Address - Phone:715-483-1505
Practice Address - Fax:715-483-9962
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI52110151223X0400X
MN117301223X0400X
TX167571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
T34317Medicare UPIN