Healthcare Provider Details

I. General information

NPI: 1285623504
Provider Name (Legal Business Name): CHERRY HILL DENTAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2005
Last Update Date: 11/25/2024
Certification Date: 11/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 DIEGO DR
COLUMBIA MO
65203-4919
US

IV. Provider business mailing address

220 DIEGO DR STE 201
COLUMBIA MO
65203-4923
US

V. Phone/Fax

Practice location:
  • Phone: 573-446-0880
  • Fax: 573-447-3121
Mailing address:
  • Phone: 573-446-0880
  • Fax: 573-447-3121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number2000158124
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. ANTHONY MICHAEL GADBOIS
Title or Position: DOCTOR
Credential: D.D.S
Phone: 573-446-0880