Provider Demographics
NPI:1902190655
Name:EVANS, KRISTEN LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:KRISTEN
Middle Name:LYNN
Last Name:EVANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:KRISTEN
Other - Middle Name:LYNN
Other - Last Name:MALONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:2445 SAND HILL RD
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-1053
Mailing Address - Country:US
Mailing Address - Phone:315-491-1604
Mailing Address - Fax:
Practice Address - Street 1:4173 PATTERSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:443-743-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-30
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD148971223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry