Provider Demographics
NPI:1255511085
Name:EVANS, EVELYN (DDS)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MOUNTAIN ST
Mailing Address - Street 2:5
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3039
Mailing Address - Country:US
Mailing Address - Phone:213-925-3114
Mailing Address - Fax:
Practice Address - Street 1:1531 N ORANGE AVE
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-1740
Practice Address - Country:US
Practice Address - Phone:626-869-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-08
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA557201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice