Provider Demographics
NPI:1154311884
Name:EALY, TODD EVANS (DDS)
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:EVANS
Last Name:EALY
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 1:9203 LEE HWY
Mailing Address - Street 2:SUITE 16
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-6458
Mailing Address - Country:US
Mailing Address - Phone:423-238-5744
Mailing Address - Fax:
Practice Address - Street 1:9203 LEE HWY
Practice Address - Street 2:SUITE 16
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-6458
Practice Address - Country:US
Practice Address - Phone:423-238-5744
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN79921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice