Provider Demographics
NPI:1811235617
Name:EFDG BATH PLLC
Entity Type:Organization
Organization Name:EFDG BATH PLLC
Other - Org Name:EAVES FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:E
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:315-536-3341
Mailing Address - Street 1:355 W MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-1029
Mailing Address - Country:US
Mailing Address - Phone:607-776-6600
Mailing Address - Fax:
Practice Address - Street 1:355 W MORRIS ST
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-1029
Practice Address - Country:US
Practice Address - Phone:607-776-6600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-29
Last Update Date:2016-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY037637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty