Provider Demographics
NPI:1477609204
Name:EVINGER, MARK A (DDS DENTIST)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:EVINGER
Suffix:
Gender:M
Credentials:DDS DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9010 CAMPO ROAD
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1111
Mailing Address - Country:US
Mailing Address - Phone:619-461-1892
Mailing Address - Fax:619-461-5228
Practice Address - Street 1:9010 CAMPO ROAD
Practice Address - Street 2:
Practice Address - City:SPRING VALLEY
Practice Address - State:CA
Practice Address - Zip Code:91977-1111
Practice Address - Country:US
Practice Address - Phone:619-461-1892
Practice Address - Fax:619-461-5228
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA400751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice