Provider Demographics
NPI:1336162510
Name:CHERYL L. RHODEN, DDS, PC
Entity type:Organization
Organization Name:CHERYL L. RHODEN, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT FOR OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILEY III
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:361-853-8999
Mailing Address - Street 1:2222 AIRLINE RD
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-2644
Mailing Address - Country:US
Mailing Address - Phone:361-853-8999
Mailing Address - Fax:361-853-4084
Practice Address - Street 1:2222 AIRLINE RD STE A4
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-2644
Practice Address - Country:US
Practice Address - Phone:361-853-8999
Practice Address - Fax:361-853-4084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX145591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091002803-03Medicaid