Provider Demographics
NPI:1114332921
Name:EVANS, ZACHARY P (DMD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:P
Last Name:EVANS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 GARDNER RD
Mailing Address - Street 2:SUITE #110
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29407-5768
Mailing Address - Country:US
Mailing Address - Phone:843-556-8778
Mailing Address - Fax:843-556-7003
Practice Address - Street 1:1064 GARDNER RD
Practice Address - Street 2:SUITE #110
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29407-5768
Practice Address - Country:US
Practice Address - Phone:843-556-8778
Practice Address - Fax:843-556-7003
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC83831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics