Provider Demographics
NPI:1124234539
Name:SMITH, CHERYL (DDS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:
Last Name:SMITH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:NICOLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1200 BRENHAM CT
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-8548
Mailing Address - Country:US
Mailing Address - Phone:214-923-6190
Mailing Address - Fax:972-463-7154
Practice Address - Street 1:6800 HERITAGE PKWY
Practice Address - Street 2:STE 202
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-8746
Practice Address - Country:US
Practice Address - Phone:972-475-0064
Practice Address - Fax:972-463-7154
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX179921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice