Healthcare Provider Details

I. General information

NPI: 1124813167
Provider Name (Legal Business Name): EMILY REANNE EVERLITH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY REANNE EVERLITH TAYLOR DMD

II. Dates (important events)

Enumeration Date: 04/10/2025
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 DALE RD STE 201
AVON CT
06001-3612
US

IV. Provider business mailing address

257 MARTIN RD
HEBRON CT
06248-1252
US

V. Phone/Fax

Practice location:
  • Phone: 860-233-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14664
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: