Provider Demographics
NPI:1558484998
Name:EVANS, HENRY FRANK III (DMD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:FRANK
Last Name:EVANS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 347
Mailing Address - Street 2:E. 616 MAIN STREET
Mailing Address - City:CHEWELAH
Mailing Address - State:WA
Mailing Address - Zip Code:99109-0347
Mailing Address - Country:US
Mailing Address - Phone:509-935-8642
Mailing Address - Fax:509-935-4103
Practice Address - Street 1:E. 616 MAIN STREET
Practice Address - Street 2:BOX 347
Practice Address - City:CHEWELAH
Practice Address - State:WA
Practice Address - Zip Code:99109-0347
Practice Address - Country:US
Practice Address - Phone:509-935-8642
Practice Address - Fax:509-935-4103
Is Sole Proprietor?:No
Enumeration Date:2007-04-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA5352122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5555701Medicaid