Provider Demographics
NPI:1205969524
Name:EVANS, MARK EDWARD
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:EDWARD
Last Name:EVANS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8925 EXECUTIVE PARK DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4708
Mailing Address - Country:US
Mailing Address - Phone:865-693-8871
Mailing Address - Fax:865-531-4851
Practice Address - Street 1:8925 EXECUTIVE PARK DR
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4708
Practice Address - Country:US
Practice Address - Phone:865-693-8871
Practice Address - Fax:865-531-4851
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4754122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist