Provider Demographics
NPI:1407008790
Name:EVANS, JOHN F (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
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 1:669 S. EASTWOOD DRIVE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:IL
Mailing Address - Zip Code:60098-4632
Mailing Address - Country:US
Mailing Address - Phone:815-337-3889
Mailing Address - Fax:815-337-3108
Practice Address - Street 1:669 S. EASTWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:IL
Practice Address - Zip Code:60098-4632
Practice Address - Country:US
Practice Address - Phone:815-337-3889
Practice Address - Fax:815-337-3108
Is Sole Proprietor?:No
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019016597122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist