Provider Demographics
NPI:1083733588
Name:EVANS, DAREN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:DAREN
Middle Name:W
Last Name:EVANS
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 1:9951 ANDERSON MILL RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-2278
Mailing Address - Country:US
Mailing Address - Phone:512-258-9466
Mailing Address - Fax:512-331-9467
Practice Address - Street 1:9951 ANDERSON MILL RD
Practice Address - Street 2:SUITE 102
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-2278
Practice Address - Country:US
Practice Address - Phone:512-258-9466
Practice Address - Fax:512-331-9467
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17018122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist