Provider Demographics
NPI:1144427964
Name:J. EVANS, DMD, P.S.
Entity Type:Organization
Organization Name:J. EVANS, DMD, P.S.
Other - Org Name:KIDDS DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER-DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JARED
Authorized Official - Middle Name:D
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:509-891-7070
Mailing Address - Street 1:1327 N STANFORD LANE
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019
Mailing Address - Country:US
Mailing Address - Phone:509-891-7070
Mailing Address - Fax:509-891-4741
Practice Address - Street 1:1327 N STANFORD LANE
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019
Practice Address - Country:US
Practice Address - Phone:509-891-7070
Practice Address - Fax:509-891-4741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA101911223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty