Provider Demographics
NPI:1861785586
Name:SMITH, CHERYL ANN (RDH-EP)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RDH-EP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 MEDFORD CTR # 392
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6772
Mailing Address - Country:US
Mailing Address - Phone:541-282-4014
Mailing Address - Fax:866-775-1369
Practice Address - Street 1:1200 MIRA MAR AVE
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8546
Practice Address - Country:US
Practice Address - Phone:541-282-4014
Practice Address - Fax:866-775-1369
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2015-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5368124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist