Provider Demographics
NPI:1679691653
Name:EVANS, RON GENE (DDS)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:GENE
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 1:113 BURNETT COURT
Mailing Address - Street 2:
Mailing Address - City:WOODWAY
Mailing Address - State:TX
Mailing Address - Zip Code:76712
Mailing Address - Country:US
Mailing Address - Phone:254-752-7671
Mailing Address - Fax:254-752-0733
Practice Address - Street 1:113 BURNETT COURT
Practice Address - Street 2:
Practice Address - City:WOODWAY
Practice Address - State:TX
Practice Address - Zip Code:76712
Practice Address - Country:US
Practice Address - Phone:254-752-7671
Practice Address - Fax:254-752-0733
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2008-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX109261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX741828496OtherTAX IDENTIFICATION NUMBER