Healthcare Provider Details

I. General information

NPI: 1700703352
Provider Name (Legal Business Name): OWEN E CHERRY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2026
Last Update Date: 07/03/2026
Certification Date: 07/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

968 1ST INFANTRY DIVISION RD
FORT KNOX KY
40121-5210
US

IV. Provider business mailing address

822 OTTER CREEK RD
VINE GROVE KY
40175-1242
US

V. Phone/Fax

Practice location:
  • Phone: 502-626-8303
  • Fax:
Mailing address:
  • Phone: 541-391-1897
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD12361
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: