Provider Demographics
NPI:1366519472
Name:CHERBAN, STEPHEN JOHN (DDS)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:JOHN
Last Name:CHERBAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2005 W 8TH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16505-4759
Mailing Address - Country:US
Mailing Address - Phone:814-456-9138
Mailing Address - Fax:
Practice Address - Street 1:2005 W 8TH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16505-4759
Practice Address - Country:US
Practice Address - Phone:814-456-9138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS20988L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist