Provider Demographics
NPI:1467678847
Name:EVANS, RAYMOND
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2993 S PEORIA ST
Mailing Address - Street 2:STE 250
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-3107
Mailing Address - Country:US
Mailing Address - Phone:303-337-9300
Mailing Address - Fax:
Practice Address - Street 1:2993 S PEORIA ST
Practice Address - Street 2:STE 250
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-3107
Practice Address - Country:US
Practice Address - Phone:303-337-9300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice