Provider Demographics
NPI:1346882255
Name:SUSAN K. EVANS, DDS, PA.
Entity Type:Organization
Organization Name:SUSAN K. EVANS, DDS, PA.
Other - Org Name:SUSAN EVANS FAMILY DENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, PA
Authorized Official - Phone:620-663-5297
Mailing Address - Street 1:1619 N LORRAINE ST
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67501-5656
Mailing Address - Country:US
Mailing Address - Phone:620-663-5297
Mailing Address - Fax:620-669-5285
Practice Address - Street 1:1619 N LORRAINE ST
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67501-5656
Practice Address - Country:US
Practice Address - Phone:620-663-5297
Practice Address - Fax:620-669-5285
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUSAN K. EVANS, D.D.S., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-10-11
Last Update Date:2020-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies