Provider Demographics
NPI:1619581188
Name:EVANS, NATALIE ELIZABETH (DDS)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:ELIZABETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7143 INTERLAAKEN DR SW
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499-1804
Mailing Address - Country:US
Mailing Address - Phone:253-381-9817
Mailing Address - Fax:
Practice Address - Street 1:1020 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-5483
Practice Address - Country:US
Practice Address - Phone:360-943-4420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-02
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE614749311223G0001X
NV74091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice