Provider Demographics
NPI:1962836031
Name:EVANS, MARK TYNDAL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:TYNDAL
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 1:7205 S 51ST AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-7399
Mailing Address - Country:US
Mailing Address - Phone:602-603-5446
Mailing Address - Fax:
Practice Address - Street 1:7205 S 51ST AVE STE 104
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339-7399
Practice Address - Country:US
Practice Address - Phone:602-603-5446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD009668122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist