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General NPI Number Information
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NPI Number | 1366748410
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Entity Type | Organization
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Legal Business Name | KORI & EVERHARTADVANCED DENTISTRY, SCOTT M. EVERHART DDS, LLC
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Dates
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Enumeration Date | 02/08/2011
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Last Update Date | 12/03/2015
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Provider Practice Location Address
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Address Line | 401 MIAMISBURG CENTERVILLE RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-4753
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Country | US
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Telephone | 937-435-5073
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Fax | 937-435-5215
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Provider Business Mailing Address
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Address Line | 401 MIAMISBURG CENTERVILLE RD
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City | CENTERVILLE
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State | OH
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Zip | 45459-4753
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Country | US
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Telephone | 937-435-5073
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Fax | 937-435-5215
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SCOTT M. EVERHART
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Credential | DDS
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Telephone | 614-579-6134
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 20908
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License Number State | OH
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