Provider Demographics
NPI:1639169121
Name:EVANS, BARRY ORRICK (DMD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:ORRICK
Last Name:EVANS
Suffix:
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 1:12887 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5813
Mailing Address - Country:US
Mailing Address - Phone:503-644-3105
Mailing Address - Fax:503-619-0066
Practice Address - Street 1:12887 NW CORNELL RD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97229-5813
Practice Address - Country:US
Practice Address - Phone:503-644-3105
Practice Address - Fax:503-619-0066
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4423122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist