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General NPI Number Information
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NPI Number | 1538203633
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Entity Type | Organization
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Legal Business Name | EDMUND E & MARILYN Y EAVES PTR
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 02/19/2009
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Provider Practice Location Address
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Address Line | 660 LIBERTY ST
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City | PENN YAN
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State | NY
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Zip | 14527-1035
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Country | US
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Telephone | 315-536-3341
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Fax | 315-536-7465
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Provider Business Mailing Address
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Address Line | 660 LIBERTY ST
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City | PENN YAN
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State | NY
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Zip | 14527-1035
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Country | US
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Telephone | 315-536-3341
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Fax | 315-536-7465
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Authorized Official
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Title or Position | PARTNER
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Name | DR. EDMUND E EAVES
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Credential | DDS
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Telephone | 315-536-3341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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