Provider Demographics
NPI:1649366790
Name:EVANS, MEREDITH (DDS)
Entity type:Individual
Prefix:
First Name:MEREDITH
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 1:125 SIEGLER ST
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54303-2635
Mailing Address - Country:US
Mailing Address - Phone:920-592-8940
Mailing Address - Fax:920-592-8953
Practice Address - Street 1:125 SIEGLER ST
Practice Address - Street 2:
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54303-2635
Practice Address - Country:US
Practice Address - Phone:920-592-8940
Practice Address - Fax:920-592-8953
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300223361223P0221X
WI64710151223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry