1942304043 NPI number — JEFF F CHEREK DDS PC

Table of content: (NPI 1942304043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942304043 NPI number — JEFF F CHEREK DDS PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFF F CHEREK DDS PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CHEREK FAMILY DENTAL
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1942304043
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6811 S 167TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OMAHA
Provider Business Mailing Address State Name:
NE
Provider Business Mailing Address Postal Code:
68135-5401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
402-861-6565
Provider Business Mailing Address Fax Number:
402-861-4118

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6811 S 167TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OMAHA
Provider Business Practice Location Address State Name:
NE
Provider Business Practice Location Address Postal Code:
68135-5401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
402-861-6565
Provider Business Practice Location Address Fax Number:
402-861-4118
Provider Enumeration Date:
09/11/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CHEREK
Authorized Official First Name:
JEFFRY
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
PRESIDENT DENTIST
Authorized Official Telephone Number:
402-861-6565

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6066N , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)