Provider Demographics
NPI:1134310782
Name:EVANS, PETER S (MS DDS MAGD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:EVANS
Suffix:
Gender:M
Credentials:MS DDS MAGD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 GREENWAY CIR
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23188-6800
Mailing Address - Country:US
Mailing Address - Phone:757-784-6705
Mailing Address - Fax:
Practice Address - Street 1:120 KINGS WAY
Practice Address - Street 2:SUITE 3600
Practice Address - City:WILLIAMSBURG
Practice Address - State:VA
Practice Address - Zip Code:23185
Practice Address - Country:US
Practice Address - Phone:757-220-1999
Practice Address - Fax:757-220-1883
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA401-00559801223G0001X
VA401005980122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice