Provider Demographics
NPI:1588087597
Name:EDWARDS EVERHART DENTAL
Entity type:Organization
Organization Name:EDWARDS EVERHART DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERHART
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-939-9912
Mailing Address - Street 1:1192 SUNCAST LANE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762
Mailing Address - Country:US
Mailing Address - Phone:916-939-9912
Mailing Address - Fax:916-939-9231
Practice Address - Street 1:1192 SUNCAST LANE
Practice Address - Street 2:SUITE 3
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762
Practice Address - Country:US
Practice Address - Phone:916-939-9912
Practice Address - Fax:916-939-9231
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA500681223G0001X
CA577681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty