Organization Name: | EVERSMILES PEDIATRIC DENTISTRY, PLLC |
NPI Number: | 1285873687 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOHN PATRICK CONRY (PARTNER) |
Mailing Address: | 4419 Air Base Road Hermantown |
State: | MN US |
Postal Code: | 558111847 |
Phone Number: | 2187282117 |
Fax Number: | 2187282700 |
NPI Enumeration Date: | 02/10/2009 |
NPI Last Update Date: | 10/06/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1223P0221X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Dental Providers |
Taxonomy Classification: | Dentist |
Taxonomy Specialization: | Pediatric Dentistry |
Taxonomy Definition: | An age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs. |