Provider Demographics
NPI:1891868279
Name:EVERS, DOYLE GARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DOYLE
Middle Name:GARY
Last Name:EVERS
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 1:3510 12TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LEWISTON
Mailing Address - State:ID
Mailing Address - Zip Code:83501-5575
Mailing Address - Country:US
Mailing Address - Phone:208-746-8249
Mailing Address - Fax:208-750-1897
Practice Address - Street 1:3510 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-5575
Practice Address - Country:US
Practice Address - Phone:208-746-8249
Practice Address - Fax:208-750-1897
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-16351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice