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General NPI Number Information
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NPI Number | 1467842823
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Entity Type | Organization
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Legal Business Name | CHERRY DENTAL
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Dates
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Enumeration Date | 01/23/2015
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Last Update Date | 01/23/2015
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Provider Practice Location Address
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Address Line | 30057 VIA VICTORIA
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-4435
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Country | US
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Telephone | 310-780-0106
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Fax |
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Provider Business Mailing Address
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Address Line | 6616 CHERRY AVE
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City | LONG BEACH
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State | CA
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Zip | 90805-1715
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Country | US
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Telephone | 562-630-5616
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Fax |
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Authorized Official
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Title or Position | ASSOCIATE DENTIST
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Name | DR. AMANDA HANNA
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Credential | DDS
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Telephone | 310-780-0106
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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