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General NPI Number Information
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NPI Number | 1386828614
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Entity Type | Organization
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Legal Business Name | CHERRYVILLE DENTAL CLINIC
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Dates
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Enumeration Date | 12/21/2007
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Last Update Date | 09/05/2013
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Provider Practice Location Address
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Address Line | 106 N MOUNTAIN ST
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City | CHERRYVILLE
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State | NC
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Zip | 28021-2941
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Country | US
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Telephone | 704-435-6916
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Fax | 704-435-6811
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Provider Business Mailing Address
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Address Line | 1015 E CHURCH ST
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City | CHERRYVILLE
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State | NC
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Zip | 28021-2916
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Country | US
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Telephone | 704-435-6916
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Fax | 704-435-6811
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL HUNTER CLONINGER
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Credential | DDS
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Telephone | 704-435-6916
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 7118
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License Number State | NC
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