Provider Demographics
NPI:1336215433
Name:SCOTT M EVERHART DDS MAMTA M KORI DDS INC
Entity Type:Organization
Organization Name:SCOTT M EVERHART DDS MAMTA M KORI DDS INC
Other - Org Name:K & E ADVANCED DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO-OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARLENE
Authorized Official - Middle Name:G
Authorized Official - Last Name:MCINTOSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-424-1834
Mailing Address - Street 1:3420 ATRIUM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-5186
Mailing Address - Country:US
Mailing Address - Phone:855-912-7677
Mailing Address - Fax:513-424-2147
Practice Address - Street 1:675 N UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45042-3355
Practice Address - Country:US
Practice Address - Phone:855-908-3676
Practice Address - Fax:513-217-5649
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH209081223G0001X
OH215411223G0001X
OH125901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2509397Medicaid