Provider Demographics
NPI:1245401728
Name:EVOLA, CHRISTOPHER A (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:EVOLA
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 1:3725 ROUTE 145
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12422-5117
Mailing Address - Country:US
Mailing Address - Phone:518-238-6486
Mailing Address - Fax:
Practice Address - Street 1:3725 ROUTE 145
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NY
Practice Address - Zip Code:12422-5117
Practice Address - Country:US
Practice Address - Phone:518-238-6486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME3258122300000X
NY0415801223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02151251Medicaid