Healthcare Provider Details

I. General information

NPI: 1013439181
Provider Name (Legal Business Name): CHERYL L RAMIREZ RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHERYL LYNN DEAN RDH

II. Dates (important events)

Enumeration Date: 07/11/2017
Last Update Date: 07/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GEBAEUDE 250 BUILDING 250 ROSE BARRACKS DENTAL CLINIC
APO AE
09112
US

IV. Provider business mailing address

CMR 411 BOX 5425
APO AE
09112-0055
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number9382146-9920
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: