Provider Demographics
NPI:1619065992
Name:EVANS, AMY (DMD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11711 N PENNSYLVANIA ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6959
Mailing Address - Country:US
Mailing Address - Phone:317-816-0841
Mailing Address - Fax:317-816-0859
Practice Address - Street 1:11711 N PENNSYLVANIA ST
Practice Address - Street 2:SUITE 114
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6959
Practice Address - Country:US
Practice Address - Phone:317-816-0841
Practice Address - Fax:317-816-0859
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120101491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice