Healthcare Provider Details

I. General information

NPI: 1629017223
Provider Name (Legal Business Name): MICHAEL LOUIS CHERUBINI D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17550 US HIGHWAY 17 N
HAMPSTEAD NC
28443-3316
US

IV. Provider business mailing address

17550 US HIGHWAY 17 N
HAMPSTEAD NC
28443-3316
US

V. Phone/Fax

Practice location:
  • Phone: 910-270-0123
  • Fax: 910-270-0129
Mailing address:
  • Phone: 910-270-0123
  • Fax: 910-270-0129

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7695
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8551
License Number StateOR
# 3
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number8286
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: