Provider Demographics
NPI:1346081916
Name:ESEVERRI, MARIA TERESA (DDS)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:ESEVERRI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 GRAND AVE UNIT A7
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-1053
Mailing Address - Country:US
Mailing Address - Phone:954-224-4011
Mailing Address - Fax:
Practice Address - Street 1:1544 W KIMBERLY RD
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52806-5529
Practice Address - Country:US
Practice Address - Phone:563-386-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-10217122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist