Provider Demographics
NPI:1699061440
Name:EVERSON, MARIA CRISTINA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:CRISTINA
Last Name:EVERSON
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 1:222 12TH ST NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-4001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:222 12TH ST NE
Practice Address - Street 2:SUITE A3EF
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-4001
Practice Address - Country:US
Practice Address - Phone:404-873-2957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019028674122300000X
GADN014396122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist