Provider Demographics
NPI:1275526881
Name:EVANS, WILLIAM R (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
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 1:8149 E 31ST ST
Mailing Address - Street 2:STE D
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1724
Mailing Address - Country:US
Mailing Address - Phone:918-665-2676
Mailing Address - Fax:918-641-5743
Practice Address - Street 1:8149 E 31ST ST
Practice Address - Street 2:STE D
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1724
Practice Address - Country:US
Practice Address - Phone:918-665-2676
Practice Address - Fax:918-641-5743
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist