Provider Demographics
NPI:1669687059
Name:EVANS, ROBERT D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:EVANS
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:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:TX
Mailing Address - Zip Code:76230-0272
Mailing Address - Country:US
Mailing Address - Phone:940-872-2581
Mailing Address - Fax:
Practice Address - Street 1:400 LINDSEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:BOWIE
Practice Address - State:TX
Practice Address - Zip Code:76230-4914
Practice Address - Country:US
Practice Address - Phone:940-872-2581
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice