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General NPI Number Information
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NPI Number | 1720086473
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Entity Type | Organization
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Legal Business Name | EVERSON DENTAL CLINIA
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Dates
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Enumeration Date | 07/07/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 201 E MAIN ST
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City | EVERSON
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State | WA
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Zip | 98247-9126
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Country | US
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Telephone | 360-966-7777
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 387
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City | EVERSON
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State | WA
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Zip | 98247-0387
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Country | US
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Telephone | 360-966-7777
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Fax | 360-966-4510
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Authorized Official
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Title or Position | DENTIST
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Name | DR. DANIEL T BARRETT
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Credential | DDS
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Telephone | 360-966-7777
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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