Provider Demographics
NPI:1962551184
Name:COVERT, EDWARD G JR (DDS, DME)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:G
Last Name:COVERT
Suffix:JR
Gender:M
Credentials:DDS, DME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 DOLPHIN DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28546-5291
Mailing Address - Country:US
Mailing Address - Phone:910-353-5171
Mailing Address - Fax:910-353-8810
Practice Address - Street 1:400 DOLPHIN DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:910-353-5171
Practice Address - Fax:910-353-8810
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC66621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59-05672Medicaid