Provider Demographics
NPI:1104587708
Name:EVEREST PC
Entity type:Organization
Organization Name:EVEREST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:ERON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:ALDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:207-852-9597
Mailing Address - Street 1:700 MOUNT HOPE AVE STE 410
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-5679
Mailing Address - Country:US
Mailing Address - Phone:207-852-9597
Mailing Address - Fax:
Practice Address - Street 1:700 MOUNT HOPE AVE STE 410
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-5679
Practice Address - Country:US
Practice Address - Phone:207-852-9597
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-05
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty