Provider Demographics
NPI:1679986541
Name:EVERNOOK DENTISTRY LLC
Entity Type:Organization
Organization Name:EVERNOOK DENTISTRY LLC
Other - Org Name:EVERNOOK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:YEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-966-3888
Mailing Address - Street 1:PO BOX 966
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-0966
Mailing Address - Country:US
Mailing Address - Phone:360-966-3888
Mailing Address - Fax:360-966-3555
Practice Address - Street 1:111 NOOKSACK AVE
Practice Address - Street 2:
Practice Address - City:NOOKSACK
Practice Address - State:WA
Practice Address - Zip Code:98276-8219
Practice Address - Country:US
Practice Address - Phone:360-966-3888
Practice Address - Fax:360-966-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-09
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty