Provider Demographics
NPI:1891895504
Name:EVANS, THOMAS BART (DDS)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:BART
Last Name:EVANS
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 1:39783 PASEO PADRE PKWY
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2926
Mailing Address - Country:US
Mailing Address - Phone:510-656-8662
Mailing Address - Fax:510-656-8951
Practice Address - Street 1:39783 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2926
Practice Address - Country:US
Practice Address - Phone:510-656-8662
Practice Address - Fax:510-656-8951
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA245431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice