Provider Demographics
NPI:1033147764
Name:EVANS, DAVID LEWIS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LEWIS
Last Name:EVANS
Suffix:JR
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 1:1455 YARMOUTH AVE
Mailing Address - Street 2:SUITE 116
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80304-4371
Mailing Address - Country:US
Mailing Address - Phone:303-442-0990
Mailing Address - Fax:303-546-9735
Practice Address - Street 1:1455 YARMOUTH AVE
Practice Address - Street 2:SUITE 116
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-4371
Practice Address - Country:US
Practice Address - Phone:303-442-0990
Practice Address - Fax:303-546-9735
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO7800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist