Provider Demographics
NPI:1427353168
Name:CHERRY HILL DENTISTRY LLC
Entity type:Organization
Organization Name:CHERRY HILL DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:A
Authorized Official - Last Name:KROEGER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:402-488-2383
Mailing Address - Street 1:249 CHERRY HILL BLVD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2602
Mailing Address - Country:US
Mailing Address - Phone:402-488-2383
Mailing Address - Fax:402-488-2384
Practice Address - Street 1:249 CHERRY HILL BLVD
Practice Address - Street 2:SUITE 5
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2602
Practice Address - Country:US
Practice Address - Phone:402-488-2383
Practice Address - Fax:402-488-2384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-11
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE39001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025472600Medicaid