Provider Demographics
NPI:1336148857
Name:EVANS, DOUGLAS BRIAN (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:BRIAN
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 1:7560 RANGEWOOD DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-4199
Mailing Address - Country:US
Mailing Address - Phone:719-388-1818
Mailing Address - Fax:719-388-1815
Practice Address - Street 1:7560 RANGEWOOD DR
Practice Address - Street 2:SUITE 310
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-4199
Practice Address - Country:US
Practice Address - Phone:719-388-1818
Practice Address - Fax:719-388-1815
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO80501223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics