Provider Demographics
NPI:1609221928
Name:EVANOFF, KARL (DDS)
Entity Type:Individual
Prefix:DR
First Name:KARL
Middle Name:
Last Name:EVANOFF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 S SHERIDAN DR
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-2650
Mailing Address - Country:US
Mailing Address - Phone:231-773-8110
Mailing Address - Fax:231-288-1307
Practice Address - Street 1:918 S SHERIDAN DR
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-2650
Practice Address - Country:US
Practice Address - Phone:231-773-8110
Practice Address - Fax:231-288-1307
Is Sole Proprietor?:No
Enumeration Date:2016-04-25
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021800122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist