Provider Demographics
NPI:1124579891
Name:EVANS, RALPH (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2004
Mailing Address - Country:US
Mailing Address - Phone:276-322-2212
Mailing Address - Fax:276-322-0032
Practice Address - Street 1:2201 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2004
Practice Address - Country:US
Practice Address - Phone:276-322-2212
Practice Address - Fax:276-322-0032
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-18
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics