Provider Demographics
NPI:1669580163
Name:EVANS, ARTHUR F (DDS)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:F
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:GRANETTE
Mailing Address - State:AR
Mailing Address - Zip Code:72736
Mailing Address - Country:US
Mailing Address - Phone:479-787-5256
Mailing Address - Fax:479-787-6950
Practice Address - Street 1:1102 JACKSON SW
Practice Address - Street 2:GRAVETTE MERCY MEDICAL CLINIC BLDG
Practice Address - City:GRAVETTE
Practice Address - State:AR
Practice Address - Zip Code:72736
Practice Address - Country:US
Practice Address - Phone:479-787-5256
Practice Address - Fax:479-787-6950
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR19521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
108957OtherUNITED CONCORDIA
58161OtherBCBS