Provider Demographics
NPI:1467634188
Name:EVANS, ROBERT WILLIAM JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WILLIAM
Last Name:EVANS
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:ROBERT
Other - Middle Name:WILLIAM
Other - Last Name:EVANS
Other - Suffix:JR
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2151 S COLLEGE DR STE 103
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93455-1304
Mailing Address - Country:US
Mailing Address - Phone:805-928-5871
Mailing Address - Fax:805-928-0765
Practice Address - Street 1:2151 S COLLEGE DR STE 103
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-1304
Practice Address - Country:US
Practice Address - Phone:805-928-5871
Practice Address - Fax:805-928-0765
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA252511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice