Provider Demographics
NPI:1487863718
Name:MAMS AND EVICK, DDS, PLLC
Entity Type:Organization
Organization Name:MAMS AND EVICK, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER AND DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIEA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVICK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-636-5800
Mailing Address - Street 1:600 S RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS
Mailing Address - State:WV
Mailing Address - Zip Code:26241-5702
Mailing Address - Country:US
Mailing Address - Phone:304-636-5800
Mailing Address - Fax:304-636-0971
Practice Address - Street 1:600 S RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ELKINS
Practice Address - State:WV
Practice Address - Zip Code:26241-5702
Practice Address - Country:US
Practice Address - Phone:304-636-5800
Practice Address - Fax:304-636-0971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV35981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty