Provider Demographics
NPI:1225277023
Name:EVANS, DEREK ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:ROBERT
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 1:720 S RIVER RD
Mailing Address - Street 2:SUITE C215
Mailing Address - City:SAINT GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5507
Mailing Address - Country:US
Mailing Address - Phone:435-986-9799
Mailing Address - Fax:435-986-0699
Practice Address - Street 1:720 S RIVER RD
Practice Address - Street 2:SUITE C215
Practice Address - City:SAINT GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5507
Practice Address - Country:US
Practice Address - Phone:435-986-9799
Practice Address - Fax:435-986-0699
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT6231362-99211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice