NPI 1083660021

Cherry Lane Dental

Organisation Point of Service Meridian, ID

Practice location

Address: 1104 W Cherry Ln, Meridian, ID 83642-1513
Phone: (208) 888-7889

Authorised official

Name: John Andrew Bergloff
Title: President
Phone: (208) 888-7889

Registered specialties

Point of Service Primary

Managed Care Organizations Taxonomy 305S00000X Licence D-3409 (ID)

Other Point of Service providers in Idaho →

Registry record

NPI: 1083660021
Entity type: Organization
NPI issued: 25 May 2006
Record last updated: 22 Aug 2020

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.