Provider Demographics
NPI:1689748071
Name:EVANS, GEORGE J (DDS)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:J
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 1:740 EAST PENNSYLVANIA AVENUE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:OTTUMWA
Mailing Address - State:IA
Mailing Address - Zip Code:52501-2100
Mailing Address - Country:US
Mailing Address - Phone:641-683-1601
Mailing Address - Fax:
Practice Address - Street 1:740 EAST PENNSYLVANIA AVENUE
Practice Address - Street 2:SUITE 2
Practice Address - City:OTTUMWA
Practice Address - State:IA
Practice Address - Zip Code:52501-2100
Practice Address - Country:US
Practice Address - Phone:641-683-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA065591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice