Provider Demographics
NPI:1023395332
Name:G. BRIAN EVES, D.D.S.
Entity Type:Organization
Organization Name:G. BRIAN EVES, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:BRIAN
Authorized Official - Last Name:EVES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-523-2332
Mailing Address - Street 1:PO BOX 599
Mailing Address - Street 2:
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535-0599
Mailing Address - Country:US
Mailing Address - Phone:304-523-2332
Mailing Address - Fax:304-523-0681
Practice Address - Street 1:4602 ROUTE 152
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535-9702
Practice Address - Country:US
Practice Address - Phone:304-523-2332
Practice Address - Fax:304-523-0681
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0013024000Medicaid