Provider Demographics
NPI:1871504464
Name:CATHERINE B EVANS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:CATHERINE B EVANS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-893-5721
Mailing Address - Street 1:PO BOX 1296
Mailing Address - Street 2:
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546-1296
Mailing Address - Country:US
Mailing Address - Phone:910-893-5721
Mailing Address - Fax:910-893-8107
Practice Address - Street 1:205 W FRONT ST
Practice Address - Street 2:
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546-1296
Practice Address - Country:US
Practice Address - Phone:910-893-5721
Practice Address - Fax:910-893-8107
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC50111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8992514Medicaid
NC8992514Medicaid