Healthcare Provider Details

I. General information

NPI: 1700089984
Provider Name (Legal Business Name): ROBERT A CHERON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2007
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 FAIRFAX DR SUITE 440
ARLINGTON VA
22203-1772
US

IV. Provider business mailing address

1105 RUSSELL RD
ALEXANDRIA VA
22301-2436
US

V. Phone/Fax

Practice location:
  • Phone: 703-528-8382
  • Fax: 703-469-1708
Mailing address:
  • Phone: 267-252-0125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number54531
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401412778
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: