Provider Demographics
NPI:1275422933
Name:CHEROKEE STREET DENTAL
Entity type:Organization
Organization Name:CHEROKEE STREET DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOHERTY
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:770-425-4100
Mailing Address - Street 1:2933 CHEROKEE ST NW STE 200
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-6527
Mailing Address - Country:US
Mailing Address - Phone:770-425-4100
Mailing Address - Fax:770-425-4111
Practice Address - Street 1:2933 CHEROKEE ST NW STE 200
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-6527
Practice Address - Country:US
Practice Address - Phone:770-425-4100
Practice Address - Fax:770-425-4111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-30
Last Update Date:2025-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty