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General NPI Number Information
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NPI Number | 1295890895
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Entity Type | Organization
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Legal Business Name | CHEROKEE DENTAL, P.A.
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Dates
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Enumeration Date | 12/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 374 ANNAPOLIS ST W
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City | SAINT PAUL
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State | MN
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Zip | 55118-1107
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Country | US
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Telephone | 651-457-6231
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Fax | 651-457-8008
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Provider Business Mailing Address
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Address Line | 374 ANNAPOLIS ST W
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City | SAINT PAUL
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State | MN
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Zip | 55118-1107
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Country | US
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Telephone | 651-457-6231
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Fax | 651-457-8008
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID DOUGLAS VANDEVELDE
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Credential | D.D.S.
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Telephone | 651-457-6231
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D8801
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License Number State | MN
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