Provider Demographics
NPI:1740577246
Name:TODD E. EALY D.D.S.
Entity Type:Organization
Organization Name:TODD E. EALY D.D.S.
Other - Org Name:WOLFTEVER DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TODD
Authorized Official - Middle Name:
Authorized Official - Last Name:EALY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:423-238-5744
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:423-238-5786
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:423-238-5786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-05
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
7992122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty