Provider Demographics
NPI:1023192127
Name:EVANS ORTHODONTICS
Entity Type:Organization
Organization Name:EVANS ORTHODONTICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS MS
Authorized Official - Phone:605-342-7777
Mailing Address - Street 1:600 DAKOTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-0920
Mailing Address - Country:US
Mailing Address - Phone:605-342-7777
Mailing Address - Fax:605-342-2275
Practice Address - Street 1:600 DAKOTA DRIVE
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-0920
Practice Address - Country:US
Practice Address - Phone:605-342-7777
Practice Address - Fax:605-342-2275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDM7191223X0400X
SDM9141223X0400X
SDM2671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty