Provider Demographics
NPI:1083760896
Name:WILLIAM R. EVANS, DDS, APC
Entity Type:Organization
Organization Name:WILLIAM R. EVANS, DDS, APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-694-5150
Mailing Address - Street 1:16635 CENTERFIELD DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7719
Mailing Address - Country:US
Mailing Address - Phone:907-694-5150
Mailing Address - Fax:907-694-1317
Practice Address - Street 1:16635 CENTERFIELD DR
Practice Address - Street 2:SUITE 205
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7719
Practice Address - Country:US
Practice Address - Phone:907-694-5150
Practice Address - Fax:907-694-1317
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0555Medicaid