Healthcare Provider Details

I. General information

NPI: 1487872214
Provider Name (Legal Business Name): CHRISTOPHER SHEA CHEUVRONT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 SARAHS LN
SOMERSET KY
42503-2789
US

IV. Provider business mailing address

87 SARAHS LN
SOMERSET KY
42503-2789
US

V. Phone/Fax

Practice location:
  • Phone: 606-679-3010
  • Fax: 606-679-2181
Mailing address:
  • Phone: 606-679-3010
  • Fax: 606-679-2181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8221
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8221
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: