Provider Demographics
NPI:1669500849
Name:EVANS, WILLIAM JENNINGS (DDS)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:JENNINGS
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9727 GREENSIDE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:COCKEYSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21030-5030
Mailing Address - Country:US
Mailing Address - Phone:410-628-0086
Mailing Address - Fax:410-628-0086
Practice Address - Street 1:9727 GREENSIDE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:COCKEYSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21030-5030
Practice Address - Country:US
Practice Address - Phone:410-628-0086
Practice Address - Fax:410-628-0086
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD069441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice