Provider Demographics
NPI:1033106000
Name:EVANS, JONATHAN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:DAVID
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:JONATHAN
Other - Middle Name:DAVID
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:52D MEDICAL GROUP
Mailing Address - Street 2:UNIT 3865
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09126-3865
Mailing Address - Country:US
Mailing Address - Phone:49656-591-3590
Mailing Address - Fax:
Practice Address - Street 1:301 FISHER ST
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39534
Practice Address - Country:US
Practice Address - Phone:228-376-0511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194821223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry