Provider Demographics
NPI:1639961410
Name:EVERSMILE DENTIST PLLC
Entity type:Organization
Organization Name:EVERSMILE DENTIST PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-331-9840
Mailing Address - Street 1:3624 JOE BATTLE BLVD UNIT 110
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-2628
Mailing Address - Country:US
Mailing Address - Phone:915-219-7773
Mailing Address - Fax:915-219-7078
Practice Address - Street 1:3624 JOE BATTLE BLVD UNIT 110
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2628
Practice Address - Country:US
Practice Address - Phone:915-219-7773
Practice Address - Fax:915-219-7078
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-05-19
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty