Provider Demographics
NPI:1154464287
Name:EVERETT, CAROL ANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:ANN
Last Name:EVERETT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3408 OAK PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BERWYN
Mailing Address - State:IL
Mailing Address - Zip Code:60402-3617
Mailing Address - Country:US
Mailing Address - Phone:708-788-8514
Mailing Address - Fax:
Practice Address - Street 1:2140 CLARENCE AVE
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-1902
Practice Address - Country:US
Practice Address - Phone:708-788-8700
Practice Address - Fax:708-788-8718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice