Provider Demographics
NPI:1235622218
Name:EVANS, AUBRIE J (DDS)
Entity Type:Individual
Prefix:
First Name:AUBRIE
Middle Name:J
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2301 S HIGHWAY 65 STE 1
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3713
Mailing Address - Country:US
Mailing Address - Phone:660-202-9593
Mailing Address - Fax:660-675-3002
Practice Address - Street 1:2301 S HIGHWAY 65 STE 1
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3713
Practice Address - Country:US
Practice Address - Phone:660-886-9500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20180191291223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235622218OtherINDIVIDUAL