Healthcare Provider Details

I. General information

NPI: 1518036235
Provider Name (Legal Business Name): LISA MARIE CHERRY DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 12/06/2023
Certification Date: 12/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 HALTON RD STE B
GREENVILLE SC
29607-3507
US

IV. Provider business mailing address

101 HALTON RD STE B
GREENVILLE SC
29607-3507
US

V. Phone/Fax

Practice location:
  • Phone: 864-603-2603
  • Fax: 864-603-2606
Mailing address:
  • Phone: 864-603-2603
  • Fax: 864-603-2606

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number4417
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: