Organization
CHERRY STREET SERVICES, INC.
Active
Organization
CHERRY STREET SERVICES, INC.
Active
Other names
Ferguson Dental
Organization subpart
No
Provider details
NPI number
Authorized official
TASHA BLACKMON (CEO)
(616) 776-2120
Entity
Organization
Contact information
Practice address
101 SHELDON BLVD SE STE 1, GRAND RAPIDS, MI 49503-4950
(616) 776-2340
(616) 776-2341
Mailing address
100 CHERRY ST SE, GRAND RAPIDS, MI 49503-4526
(616) 965-8200
(616) 940-5366
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
—
—
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Enumeration date
09/11/2008
Last updated
08/25/2023
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