Provider Demographics
NPI:1245352517
Name:WILLETT, CHERYL LEE (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LEE
Last Name:WILLETT
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 SONOMA AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4813
Mailing Address - Country:US
Mailing Address - Phone:707-544-4611
Mailing Address - Fax:
Practice Address - Street 1:1111 SONOMA AVE STE 102
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4813
Practice Address - Country:US
Practice Address - Phone:707-544-4611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2023-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492471223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry