Provider Demographics
NPI:1699877571
Name:COLKER, CHERYL ANN (DMD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:COLKER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:647 CAMINO DE LOS MARES
Mailing Address - Street 2:SUITE 108-133
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-2825
Mailing Address - Country:US
Mailing Address - Phone:949-366-0291
Mailing Address - Fax:949-340-2538
Practice Address - Street 1:171 AVENIDA VAQUERO
Practice Address - Street 2:SUITE #A
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3601
Practice Address - Country:US
Practice Address - Phone:949-366-0291
Practice Address - Fax:949-340-2538
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA340201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice