Provider Demographics
NPI:1447368915
Name:JOHN K EVERSMAN DDS INC
Entity type:Organization
Organization Name:JOHN K EVERSMAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVERSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-238-1774
Mailing Address - Street 1:120 W MAIN ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891
Mailing Address - Country:US
Mailing Address - Phone:419-238-1774
Mailing Address - Fax:419-238-2110
Practice Address - Street 1:120 W MAIN ST
Practice Address - Street 2:SUITE 300
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891
Practice Address - Country:US
Practice Address - Phone:419-238-1774
Practice Address - Fax:419-238-2110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30013665122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty