Provider Demographics
NPI:1255462776
Name:EVANS, DAVID GEORGE (DDSPC)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:GEORGE
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 510
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-0510
Mailing Address - Country:US
Mailing Address - Phone:406-446-2814
Mailing Address - Fax:406-446-1559
Practice Address - Street 1:24 S OAKES AVENUE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-0510
Practice Address - Country:US
Practice Address - Phone:406-446-2814
Practice Address - Fax:406-446-1559
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT15671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice