Doctor Name: | EVERETT MAYNARD |
NPI Number: | 1912347253 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | D.D.S. |
License Number: | 7089 |
Business Practice Address: | 295 N Walsh Dr Casper, WY - 826091911 |
Business Phone Number: | 3072657878 |
Business Fax Number: | |
Mailing Address: | 3361 E 18th St, CASPER |
State: | WY |
Postal Code: | 826093513 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/01/2013 |
NPI Last Update Date: | 01/25/2016 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | 7089 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NE |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |