Provider Demographics
NPI:1285657833
Name:EVASKUS, DAVID S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:EVASKUS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2440 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4113
Mailing Address - Country:US
Mailing Address - Phone:773-761-7171
Mailing Address - Fax:773-761-6714
Practice Address - Street 1:2440 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4113
Practice Address - Country:US
Practice Address - Phone:773-761-7171
Practice Address - Fax:773-761-6714
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILT37869Medicare UPIN
IL527100Medicare PIN