Provider Demographics
NPI:1689241481
Name:AUBRIE EVANS DDS LLC
Entity Type:Organization
Organization Name:AUBRIE EVANS DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AUBRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-202-9593
Mailing Address - Street 1:2301 S HIGHWAY 65 STE 1
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-3713
Mailing Address - Country:US
Mailing Address - Phone:660-202-9593
Mailing Address - Fax:
Practice Address - Street 1:2301 S HIGHWAY 65 STE 1
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-3713
Practice Address - Country:US
Practice Address - Phone:660-202-9593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental