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General NPI Number Information
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NPI Number | 1730217191
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Entity Type | Individual
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Provider Name | THOMAS FORD EVERETT DDS
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Gender | Male
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | FAMILY ORTHODONTIC SPECIALISTS 14344 BURNHAVEN DR
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City | BURNSVILLE
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State | MN
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Zip | 55306-5306
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Country | US
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Telephone | 952-435-6213
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Fax |
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Provider Business Mailing Address
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Address Line | FAMILY ORTHODONTICS SPECIALISTS 6601 LYNDALE AVE S #220
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City | RICHFIELD
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State | MN
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Zip | 55423-5423
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Country | US
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Telephone | 612-861-9141
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | S15
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License Number State | MN
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