Provider Demographics
NPI:1821163510
Name:STALKER, EVERETT M (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVERETT
Middle Name:M
Last Name:STALKER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BLUE HERON DRIVE
Mailing Address - Street 2:
Mailing Address - City:BARNEVELD
Mailing Address - State:NY
Mailing Address - Zip Code:13304
Mailing Address - Country:US
Mailing Address - Phone:315-896-2460
Mailing Address - Fax:
Practice Address - Street 1:7990 STATE RTE 12
Practice Address - Street 2:SUITE 1
Practice Address - City:BARNEVELD
Practice Address - State:NY
Practice Address - Zip Code:13304
Practice Address - Country:US
Practice Address - Phone:315-896-7293
Practice Address - Fax:315-896-7294
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY04748611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice