Provider Demographics
NPI:1033128277
Name:EVANSECK, RICHARD ANDREW (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ANDREW
Last Name:EVANSECK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2503
Mailing Address - Country:US
Mailing Address - Phone:765-664-2115
Mailing Address - Fax:765-664-2124
Practice Address - Street 1:1007 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2503
Practice Address - Country:US
Practice Address - Phone:765-664-2115
Practice Address - Fax:765-664-2124
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120096601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice