Provider Demographics
NPI:1558431833
Name:EVANSON, ANGELA S (DDS)
Entity Type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:S
Last Name:EVANSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:S
Other - Last Name:EVANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:17167 CEDAR GULCH PKWY
Mailing Address - Street 2:202
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-4410
Mailing Address - Country:US
Mailing Address - Phone:303-805-9999
Mailing Address - Fax:303-805-9109
Practice Address - Street 1:17167 CEDAR GULCH PKWY
Practice Address - Street 2:202
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-4410
Practice Address - Country:US
Practice Address - Phone:303-805-9999
Practice Address - Fax:303-805-9109
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO7556122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO300509846OtherSTATE OF COLORADO