Provider Demographics
NPI:1144379306
Name:EVANS, RONALD GLENN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:GLENN
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 1:510 TURTLE COVE BLVD
Mailing Address - Street 2:SUITE#107
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75087-5385
Mailing Address - Country:US
Mailing Address - Phone:972-771-0977
Mailing Address - Fax:972-722-8348
Practice Address - Street 1:510 TURTLE COVE BLVD
Practice Address - Street 2:SUITE#107
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-5385
Practice Address - Country:US
Practice Address - Phone:972-771-0977
Practice Address - Fax:972-722-8348
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist