Provider Demographics
NPI:1790242204
Name:EVERSHINE DENTAL LLC
Entity Type:Organization
Organization Name:EVERSHINE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHANA
Authorized Official - Middle Name:SHERYL
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:BDS, DMD
Authorized Official - Phone:978-888-8028
Mailing Address - Street 1:100 MLK JR BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1209
Mailing Address - Country:US
Mailing Address - Phone:774-243-7782
Mailing Address - Fax:774-243-7787
Practice Address - Street 1:100 MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608
Practice Address - Country:US
Practice Address - Phone:978-888-8028
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-02-21
Last Update Date:2019-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty