Healthcare Provider Details

I. General information

NPI: 1972686319
Provider Name (Legal Business Name): WENDY KATZ EVERHART DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KENNEDY DRIVE U6
SO BURLINGTON VT
05403
US

IV. Provider business mailing address

1 KENNEDY DRIVE U6
SOUTH BURLINGTON VT
05403
US

V. Phone/Fax

Practice location:
  • Phone: 802-862-6562
  • Fax: 802-862-6562
Mailing address:
  • Phone: 802-862-6562
  • Fax: 802-862-6562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0160000890
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: