Provider Demographics
NPI:1669889903
Name:CHAMOUN, CHERESTINA (DDS)
Entity type:Individual
Prefix:
First Name:CHERESTINA
Middle Name:
Last Name:CHAMOUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CHERESTINA
Other - Middle Name:
Other - Last Name:BOULAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3725 SUNGATE DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5267
Mailing Address - Country:US
Mailing Address - Phone:310-592-5369
Mailing Address - Fax:
Practice Address - Street 1:300 E PALMDALE BLVD
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4517
Practice Address - Country:US
Practice Address - Phone:661-272-9000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-18
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63607122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist