Provider Demographics
NPI:1275583809
Name:EVANS, DENISE NICOLE (DDS)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:NICOLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 DOUGLAS AVENUE
Mailing Address - Street 2:STE 26
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322
Mailing Address - Country:US
Mailing Address - Phone:515-278-2333
Mailing Address - Fax:515-278-5492
Practice Address - Street 1:8515 DOUGLAS AVENUE
Practice Address - Street 2:STE 26
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322
Practice Address - Country:US
Practice Address - Phone:515-278-2333
Practice Address - Fax:515-278-5492
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IA80381223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1086108Medicaid