Provider Demographics
NPI:1346731478
Name:GEORGE E EVANS DDS PA
Entity Type:Organization
Organization Name:GEORGE E EVANS DDS PA
Other - Org Name:DENTAL CARE OF BALTIMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-922-1601
Mailing Address - Street 1:5415 OLD COURT RD STE 501
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-5171
Mailing Address - Country:US
Mailing Address - Phone:410-922-1601
Mailing Address - Fax:410-922-6145
Practice Address - Street 1:5415 OLD COURT RD STE 501
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-5171
Practice Address - Country:US
Practice Address - Phone:410-922-1601
Practice Address - Fax:410-922-6145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-24
Last Update Date:2018-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD72381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty