Provider Demographics
NPI:1417570011
Name:EVERETT, AKEIA C (DDS)
Entity type:Individual
Prefix:
First Name:AKEIA
Middle Name:C
Last Name:EVERETT
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 1:13900 LAUREL LAKES AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5021
Mailing Address - Country:US
Mailing Address - Phone:301-483-6767
Mailing Address - Fax:207-947-0435
Practice Address - Street 1:13900 LAUREL LAKES AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-5021
Practice Address - Country:US
Practice Address - Phone:301-483-6767
Practice Address - Fax:207-947-0435
Is Sole Proprietor?:No
Enumeration Date:2020-05-19
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17819122300000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program