Provider Demographics
NPI:1891014064
Name:EVANS, WILLIAM R III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:EVANS
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16635 CENTERFIELD DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-7719
Mailing Address - Country:US
Mailing Address - Phone:907-694-5150
Mailing Address - Fax:907-694-1317
Practice Address - Street 1:16635 CENTERFIELD DR
Practice Address - Street 2:SUITE 205
Practice Address - City:EAGLE RIVER
Practice Address - State:AK
Practice Address - Zip Code:99577-7719
Practice Address - Country:US
Practice Address - Phone:907-694-5150
Practice Address - Fax:907-694-1317
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AK5551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKDD0555Medicaid