Provider Demographics
NPI:1760537591
Name:EVES, GARY BRIAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:BRIAN
Last Name:EVES
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 599
Mailing Address - Street 2:4602 RT 152
Mailing Address - City:LAVALETTE
Mailing Address - State:WV
Mailing Address - Zip Code:25535
Mailing Address - Country:US
Mailing Address - Phone:304-523-2332
Mailing Address - Fax:304-523-0681
Practice Address - Street 1:4602 RT 152
Practice Address - Street 2:
Practice Address - City:LAVALETTE
Practice Address - State:WV
Practice Address - Zip Code:25535
Practice Address - Country:US
Practice Address - Phone:304-523-2332
Practice Address - Fax:304-523-0681
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV32181223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0134173000Medicaid