Basic Information
| Provider Information | |||||||||
| NPI: | 1609347657 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CHERRY | ||||||||
| FirstName: | AIMEE | ||||||||
| MiddleName: | RACHELLE | ||||||||
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| Credential: | RDH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14921 N HIGHWAY 59 | ||||||||
| Address2: | |||||||||
| City: | SUMMERS | ||||||||
| State: | AR | ||||||||
| PostalCode: | 727699690 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4797909261 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | SAM HIDER DENTAL CLINIC | ||||||||
| Address2: | 859 E MELTON DR. | ||||||||
| City: | JAY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9182531700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2018 | ||||||||
| LastUpdateDate: | 12/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 124Q00000X | 4252 | OK | Y | Dental Providers | Dental Hygienist |
No ID Information.