Provider Demographics
NPI:1073688529
Name:EVERETT & HOWELL DDS
Entity Type:Organization
Organization Name:EVERETT & HOWELL DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:EVERETT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-329-1989
Mailing Address - Street 1:202 TUNNELTON ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1452
Mailing Address - Country:US
Mailing Address - Phone:304-329-1989
Mailing Address - Fax:304-329-2550
Practice Address - Street 1:202 TUNNELTON ST
Practice Address - Street 2:SUITE 214
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1452
Practice Address - Country:US
Practice Address - Phone:304-329-1989
Practice Address - Fax:304-329-2550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV30951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001428639OtherBLUE CROSS
WV3810004440Medicaid