Healthcare Provider Details

I. General information

NPI: 1356420467
Provider Name (Legal Business Name): DAVID S CHERMAK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1564 N PEACE HAVEN RD
WINSTON SALEM NC
27104-1328
US

IV. Provider business mailing address

1564 N PEACE HAVEN RD
WINSTON SALEM NC
27104-1328
US

V. Phone/Fax

Practice location:
  • Phone: 336-760-1491
  • Fax: 336-760-3944
Mailing address:
  • Phone: 336-760-1491
  • Fax: 336-760-3944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7050
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: