Provider Demographics
NPI:1437506482
Name:EVANS, ALBERT (RDH)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 PIEDMONT ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-2609
Mailing Address - Country:US
Mailing Address - Phone:541-686-8537
Mailing Address - Fax:
Practice Address - Street 1:1230 PIEDMONT ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-2609
Practice Address - Country:US
Practice Address - Phone:541-686-8537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-19
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH6816124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist