Provider Demographics
NPI:1386681427
Name:EVANS, ERON J (DDS)
Entity Type:Individual
Prefix:DR
First Name:ERON
Middle Name:J
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:374 ROANOKE DR
Mailing Address - Street 2:
Mailing Address - City:CHUBBUCK
Mailing Address - State:ID
Mailing Address - Zip Code:83202
Mailing Address - Country:US
Mailing Address - Phone:208-238-1583
Mailing Address - Fax:
Practice Address - Street 1:390 S 3RD W
Practice Address - Street 2:MOUNTAIN VIEW DENTAL
Practice Address - City:SODA SPRINGS
Practice Address - State:ID
Practice Address - Zip Code:83276
Practice Address - Country:US
Practice Address - Phone:208-547-2220
Practice Address - Fax:208-547-2224
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD3891122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist