Provider Demographics
NPI:1780931444
Name:EVERETT, JOSEPH DYLAN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DYLAN
Last Name:EVERETT
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 1:6123 79TH ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-8708
Mailing Address - Country:US
Mailing Address - Phone:806-674-7609
Mailing Address - Fax:806-686-1263
Practice Address - Street 1:6123 79TH ST STE 100
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-8708
Practice Address - Country:US
Practice Address - Phone:806-686-1262
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-12
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28022122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist