Healthcare Provider Details

I. General information

NPI: 1669889903
Provider Name (Legal Business Name): CHERESTINA CHAMOUN DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHERESTINA BOULAS

II. Dates (important events)

Enumeration Date: 07/18/2014
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 BRICKYARD CIR
GOLDEN CO
80403-8058
US

IV. Provider business mailing address

811 BRICKYARD CIR
GOLDEN CO
80403-8058
US

V. Phone/Fax

Practice location:
  • Phone: 661-272-9000
  • Fax:
Mailing address:
  • Phone: 310-592-5369
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0004X
TaxonomyDental Anesthesiology
License Number02786251
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00206493
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: