MEDICARE: KORI & EVERHARTADVANCED DENTISTRY, SCOTT M. EVERHART DDS, LLC

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	122300000X	Dentist	20908	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366748410
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KORI & EVERHARTADVANCED DENTISTRY, SCOTT M. EVERHART DDS, LLC

Provider Business Mailing Address
First Line	:	401 MIAMISBURG CENTERVILLE RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4753
Country	:	US
Telephone Number	:	937-435-5073
Fax Number	:	937-435-5215

Provider Business Practice Location Address
First Line	:	401 MIAMISBURG CENTERVILLE RD
Second Line	:
City	:	CENTERVILLE
State	:	OH
Zip	:	45459-4753
Country	:	US
Telephone Number	:	937-435-5073
Fax Number	:	937-435-5215

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. SCOTT M. EVERHART
Credential	:	DDS
Telephone Number	:	614-579-6134

Provider Enumeration Date	:	02/08/2011
Last Update Date	:	12/03/2015

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