Provider Demographics
NPI:1093700916
Name:EVERED, JOHN STEWART (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEWART
Last Name:EVERED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 VIA BALLENA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-3708
Mailing Address - Country:US
Mailing Address - Phone:619-342-6612
Mailing Address - Fax:
Practice Address - Street 1:227 VIA BALLENA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-3708
Practice Address - Country:US
Practice Address - Phone:619-342-6612
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA382771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice