Provider Demographics
NPI:1477765428
Name:EVERSGERD, DANIELA SCHWAMBACH KANO (DMD)
Entity Type:Individual
Prefix:DR
First Name:DANIELA
Middle Name:SCHWAMBACH KANO
Last Name:EVERSGERD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 ROSEDOWN WAY
Mailing Address - Street 2:
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-8219
Mailing Address - Country:US
Mailing Address - Phone:985-237-2750
Mailing Address - Fax:
Practice Address - Street 1:400 PINE ST
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:LA
Practice Address - Zip Code:70447-9743
Practice Address - Country:US
Practice Address - Phone:985-845-8042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT91541223G0001X
LA6434122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice