Healthcare Provider Details

I. General information

NPI: 1700172129
Provider Name (Legal Business Name): JERRY CHERY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2011
Last Update Date: 12/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1515 26TH AVE E
BRADENTON FL
34208-7707
US

IV. Provider business mailing address

PO BOX 997
PALMETTO FL
34220-0997
US

V. Phone/Fax

Practice location:
  • Phone: 941-708-7607
  • Fax: 941-708-7618
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-776-4013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN19659
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: