Provider Demographics
NPI:1871039271
Name:KARL EVANOFF, DDS, PLLC
Entity Type:Organization
Organization Name:KARL EVANOFF, DDS, PLLC
Other - Org Name:EVANOFF DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARL
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANOFF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-283-4422
Mailing Address - Street 1:2243 E APPLE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49442-4391
Mailing Address - Country:US
Mailing Address - Phone:231-773-8110
Mailing Address - Fax:
Practice Address - Street 1:2243 E APPLE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4391
Practice Address - Country:US
Practice Address - Phone:231-773-8110
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021800261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental