Healthcare Provider Details

I. General information

NPI: 1235668054
Provider Name (Legal Business Name): JOSEPH ANTHONY EVERETT DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/06/2017
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

182 CENTRAL ST
HUDSON NH
03051-4651
US

IV. Provider business mailing address

75 LINDA LN
MANCHESTER NH
03104-4709
US

V. Phone/Fax

Practice location:
  • Phone: 603-882-5455
  • Fax:
Mailing address:
  • Phone: 860-208-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number04832
License Number StateNH
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number11821
License Number StateCT
# 3
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberD010271
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: