1649558859 NPI number — JEFFREY J. EBERTING DMD, M.S. PC

Table of content: JOHN BURKIN LPC, LMHC, LPCC (NPI 1770979791)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649558859 NPI number — JEFFREY J. EBERTING DMD, M.S. PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JEFFREY J. EBERTING DMD, M.S. PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1649558859
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
619 SMITHVIEW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37803-6100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-983-3570
Provider Business Mailing Address Fax Number:
865-983-9547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
619 SMITHVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37803-6100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-983-3570
Provider Business Practice Location Address Fax Number:
865-983-9547
Provider Enumeration Date:
07/22/2011

Additional Information

Authorized Official

Authorized Official Last Name:
EBERTING
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
JENNINGS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
865-983-3570

Provider Taxonomy Codes

  • Taxonomy code: 1223X0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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