Healthcare Provider Details

I. General information

NPI: 1104587708
Provider Name (Legal Business Name): EVEREST PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2022
Last Update Date: 01/05/2022
Certification Date: 01/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 MOUNT HOPE AVE STE 410
BANGOR ME
04401-5679
US

IV. Provider business mailing address

700 MOUNT HOPE AVE STE 410
BANGOR ME
04401-5679
US

V. Phone/Fax

Practice location:
  • Phone: 207-852-9597
  • Fax:
Mailing address:
  • Phone: 207-852-9597
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DR. ERON CHARLES ALDRIDGE
Title or Position: ORAL SURGEON
Credential: DMD
Phone: 207-852-9597