Provider Demographics
NPI:1699761601
Name:VICARI-INDECK, CHERYL ANN (DMD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:VICARI-INDECK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN LAKES
Mailing Address - State:NJ
Mailing Address - Zip Code:07046-1429
Mailing Address - Country:US
Mailing Address - Phone:973-263-1919
Mailing Address - Fax:973-335-2132
Practice Address - Street 1:43 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:MOUNTAIN LAKES
Practice Address - State:NJ
Practice Address - Zip Code:07046-1429
Practice Address - Country:US
Practice Address - Phone:973-263-1919
Practice Address - Fax:973-335-2132
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI166661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice