Provider Demographics
NPI:1144331984
Name:EVERETT, MICHAEL RODNEY (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:RODNEY
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 1:3120 FIRELINE RD
Mailing Address - Street 2:
Mailing Address - City:PALMERTON
Mailing Address - State:PA
Mailing Address - Zip Code:18071-5722
Mailing Address - Country:US
Mailing Address - Phone:610-826-2001
Mailing Address - Fax:
Practice Address - Street 1:3120 FIRELINE RD
Practice Address - Street 2:
Practice Address - City:PALMERTON
Practice Address - State:PA
Practice Address - Zip Code:18071-5722
Practice Address - Country:US
Practice Address - Phone:610-826-2001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027277-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice