CHERRY LANE DENTAL (NPI# 1083660021) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083660021 |
| Entity Type | Organization |
| Organization Name | CHERRY LANE DENTAL |
| Practice Address |
1104 W Cherry Ln Meridian ID 83642-1513 |
| Practice Telephone | 2088887889 |
| Mailing Telephone | 2088887889 |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | JOHN ANDREW BERGLOFF (PRESIDENT) |
| Authorized Official Telephone | 2088887889 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 305S00000X | Point of Service | D-3409 | ID | Managed Care Organizations |
| Street Address |
1104 W CHERRY LN |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642-1513 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326087180 | John Andrew Bergloff | Dentist | 1104 W Cherry Ln, Meridian, ID 83642-1513 | 2006-06-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 305S00000X |
| Grouping | Managed Care Organizations |
| Classification | Point of Service |
| This product may also be called an open-ended HMO and offers a transition product incorporating features of both HMOs and PPOs. Beneficiaries are enrolled in an HMO but have the option to go outside the networks for an additional cost. |
| Notes: Source: "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 62 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326565516 | Practice Pros Inc | Point of Service | 2674 N Arrowwood Way, Meridian, ID 83646-4406 | 2017-08-28 |
| 1154718740 | Siena Einerprises, LLC | Point of Service | 667 E Grouse Ct, Meridian, ID 83646-4414 | 2015-04-21 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417442484 | Corbett Sousa | Point of Service | 16 12th Ave S Ste 208, Nampa, ID 83651-3937 | 2018-06-22 |
| 1679026447 | Kimberly Drewrey, Aprn, Np-c | Point of Service | 5210 Cleveland Blvd, Suite 140 #344, Caldwell, ID 83607-1796 | 2016-07-28 |
| 1063839124 | City of Blackfoot | Point of Service | 960 S Fisher Ave, Blackfoot, ID 83221-3370 | 2014-03-26 |
| 1487823886 | Bonaventure Place Retirement & Assisted Living Community | Point of Service | 5850 N Five Mile Rd, Boise, ID 83713-5466 | 2008-02-29 |
| 1689855173 | Maximum Security Inc | Point of Service | 357 W Center St, Suite 212, Pocatello, ID 83204-3236 | 2007-11-26 |
| 1700078524 | Wilkinson Georgia Idaho Senior Housing LLC | Point of Service | 840 E Dalton Ave, Coeur D Alene, ID 83815-9338 | 2007-08-15 |
| 1437208899 | Hisway, LLC | Point of Service | 348 N Orchard St, Boise, ID 83706-1627 | 2007-01-08 |
| 1740661388 | Loftus Family Dental | Point of Service | 2615 N Fruitland Ln, Coeur D Alene, ID 83815-7914 | 2015-06-09 |
| 1831468651 | Crump Enterprises | Point of Service | 11311 W Chinden Blvd, Boise, ID 83714-1021 | 2011-12-22 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.