Individual
MS. CHERYL LYNN DISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
520 COBB ST, CADILLAC, MI 49601-2588
(231) 876-6505
Mailing address
1615 MICHIGAN AVE, BALDWIN, MI 49304-7984
(231) 745-2743
(231) 745-3690
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
2902009555
MI
124Q00000X
Dental Hygienist
DH2444
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2902009555
DENTAL HYGIENIST LICENSE
MI
01
—
DH2444
DENTAL HYGIENIST LICENSE
NM
Enumeration date
03/13/2018
Last updated
03/13/2018
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