Provider Demographics
NPI:1629237557
Name:EUGENE A COVELLO DDS PC
Entity Type:Organization
Organization Name:EUGENE A COVELLO DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:COVELLO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:970-963-3010
Mailing Address - Street 1:289 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:CO
Mailing Address - Zip Code:81623-2548
Mailing Address - Country:US
Mailing Address - Phone:970-963-3010
Mailing Address - Fax:970-963-4104
Practice Address - Street 1:289 MAIN ST
Practice Address - Street 2:
Practice Address - City:CARBONDALE
Practice Address - State:CO
Practice Address - Zip Code:81623-2548
Practice Address - Country:US
Practice Address - Phone:970-963-3010
Practice Address - Fax:970-963-4104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-05
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COHD7811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty