MEDICARE: DR. NATHAN P CHEROF D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DEN.00201970	CO

General Provider Information

NPI Number	:	1477819894
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN P CHEROF D.M.D.

Provider Business Mailing Address
First Line	:	3622 LOWELL BLVD
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80211-2762
Country	:	US
Telephone Number	:	404-889-3223
Fax Number	:

Provider Business Practice Location Address
First Line	:	31226 LEWIS RIDGE RD
Second Line	:
City	:	EVERGREEN
State	:	CO
Zip	:	80439-7998
Country	:	US
Telephone Number	:	303-674-5566
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2012
Last Update Date	:	06/18/2013

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