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General NPI Number Information
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NPI Number | 1740342690
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Entity Type | Organization
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Legal Business Name | JACK I CHERIN DMD
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5101 PRINCESS ANNE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462
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Country | US
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Telephone | 757-497-8611
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Fax | 757-499-7730
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Provider Business Mailing Address
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Address Line | 5101 PRINCESS ANNE RD
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City | VIRGINIA BEACH
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State | VA
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Zip | 23462
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Country | US
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Telephone | 757-497-8611
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Fax | 757-499-7730
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Authorized Official
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Title or Position | OWNER
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Name | JACK I CHERIN
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Credential | DMD
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Telephone | 757-497-8611
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number | 0401003088
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License Number State | VA
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