Individual
EVERETT MAYNARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
7089
NE
1223P0221X
Pediatric Dentistry
Primary
1343
WY
390200000X
Student in an Organized Health Care Education/Training Program
7089
NE
Other
Enumeration date
07/01/2013
Last updated
01/25/2016
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