Provider Demographics
NPI:1083691281
Name:EVERS, MARTIN E JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:E
Last Name:EVERS
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 808 BOX 19
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09618-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:VIA CONTRADA BOSCARIELLO
Practice Address - Street 2:
Practice Address - City:GRICIGNANO DI AVERSA
Practice Address - State:CAMPANIA
Practice Address - Zip Code:81030
Practice Address - Country:IT
Practice Address - Phone:314-629-6007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0510031223G0001X
NY051003-11223X0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0008XDental ProvidersDentistOral and Maxillofacial Radiology
No1223G0001XDental ProvidersDentistGeneral Practice