Provider Demographics
NPI:1093037558
Name:CHERYL D. BINGHAM
Entity type:Organization
Organization Name:CHERYL D. BINGHAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:D
Authorized Official - Last Name:BINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-564-7504
Mailing Address - Street 1:11905 S CENTRAL AVE # 203
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2836
Mailing Address - Country:US
Mailing Address - Phone:323-564-7504
Mailing Address - Fax:323-564-8645
Practice Address - Street 1:11905 S CENTRAL AVE # 203
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2836
Practice Address - Country:US
Practice Address - Phone:323-564-7504
Practice Address - Fax:323-564-8645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA034818305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization