Provider Demographics
NPI:1235484916
Name:EVANS, HARVEY FRANK JR
Entity Type:Individual
Prefix:DR
First Name:HARVEY
Middle Name:FRANK
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 15TH ST N
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-1008
Mailing Address - Country:US
Mailing Address - Phone:515-332-5328
Mailing Address - Fax:515-332-3411
Practice Address - Street 1:1014 15TH ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548-1008
Practice Address - Country:US
Practice Address - Phone:515-332-5328
Practice Address - Fax:515-332-3411
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-18
Last Update Date:2012-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06971122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist