Healthcare Provider Details

I. General information

NPI: 1619955929
Provider Name (Legal Business Name): STEPHEN SHAE CHERRINGTON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2006
Last Update Date: 10/05/2023
Certification Date: 10/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIR # B7500
FT CARSON CO
80913-4613
US

IV. Provider business mailing address

1650 COCHRANE CIR # B7500
FT CARSON CO
80913-4613
US

V. Phone/Fax

Practice location:
  • Phone: 706-836-8440
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number5933858
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5933858-9926
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number9453
License Number StateTN
# 4
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number5933858-9921
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: