Provider Demographics
NPI:1285623504
Name:CHERRY HILL DENTAL ASSOCIATES INC
Entity type:Organization
Organization Name:CHERRY HILL DENTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GADBOIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-446-0880
Mailing Address - Street 1:220 DIEGO DR STE 201
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-4923
Mailing Address - Country:US
Mailing Address - Phone:573-446-0880
Mailing Address - Fax:573-447-3121
Practice Address - Street 1:220 DIEGO DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65203-4919
Practice Address - Country:US
Practice Address - Phone:573-446-0880
Practice Address - Fax:573-447-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1223G0001X
MO2000158124261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental