MEDICARE: EVELETH DENTAL ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		MN

General Provider Information

NPI Number	:	1114098720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVELETH DENTAL ASSOCIATES

Provider Business Mailing Address
First Line	:	320 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1524
Country	:	US
Telephone Number	:	218-744-5440
Fax Number	:	218-744-5441

Provider Business Practice Location Address
First Line	:	320 GRANT AVE
Second Line	:
City	:	EVELETH
State	:	MN
Zip	:	55734-1524
Country	:	US
Telephone Number	:	218-744-5440
Fax Number	:	218-744-5441

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARY E EPP
Credential	:	DDS
Telephone Number	:	218-744-5440

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	08/22/2020

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1174866255 — DR. GARY EUGENE EPP DDS
Practice Location Address:

320 GRANT AVE
EVELETH, MN
55734-1524

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Practice Location Address:

318 GRANT AVE
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