Provider Demographics
NPI:1811189996
Name:DEREK R. EVANS DMD PC
Entity Type:Organization
Organization Name:DEREK R. EVANS DMD PC
Other - Org Name:GENTLE DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:435-986-9799
Mailing Address - Street 1:720 S RIVER RD
Mailing Address - Street 2:SUITE C 215
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-5507
Mailing Address - Country:US
Mailing Address - Phone:435-986-9799
Mailing Address - Fax:435-986-0699
Practice Address - Street 1:720 S RIVER RD
Practice Address - Street 2:SUITE C 215
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-5507
Practice Address - Country:US
Practice Address - Phone:435-986-9799
Practice Address - Fax:435-986-0699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental