Provider Demographics
NPI:1881840924
Name:CHEROKEE DENTAL CENTER, P.C.
Entity type:Organization
Organization Name:CHEROKEE DENTAL CENTER, P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:HAMNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-238-3518
Mailing Address - Street 1:NG34 LAKE CHEROKEE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-9515
Mailing Address - Country:US
Mailing Address - Phone:903-643-8442
Mailing Address - Fax:903-983-2980
Practice Address - Street 1:3210 STONE RD STE B
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-2966
Practice Address - Country:US
Practice Address - Phone:903-984-2047
Practice Address - Fax:903-983-2980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-08
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22188261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1124111984OtherNPI