Provider Demographics
NPI:1609995109
Name:JAMES G. EVANS D.D.S., INC.
Entity Type:Organization
Organization Name:JAMES G. EVANS D.D.S., INC.
Other - Org Name:TRIAD DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:GLENNON
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-441-7440
Mailing Address - Street 1:1400 TRIAD CENTER DR
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376-7351
Mailing Address - Country:US
Mailing Address - Phone:636-441-7440
Mailing Address - Fax:636-441-9594
Practice Address - Street 1:1400 TRIAD CENTER DR
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-7351
Practice Address - Country:US
Practice Address - Phone:636-441-7440
Practice Address - Fax:636-441-9594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO013030261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental