Provider Demographics
NPI:1275909863
Name:EVANS, EDWARD E JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:E
Last Name:EVANS
Suffix:JR
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:USA DENTAC LANDSTUHL
Mailing Address - Street 2:CMR 402
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LANDSTUL DENTAL ACTIVITY
Practice Address - Street 2:BLDG 3703 KIRCHBERG KASERNE
Practice Address - City:LANDSTUHL
Practice Address - State:RP
Practice Address - Zip Code:66849
Practice Address - Country:DE
Practice Address - Phone:011496-371-9464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-18
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9501074-9921122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist