Provider Demographics
NPI:1740663475
Name:MINERAL WELLS, PLLC
Entity type:Organization
Organization Name:MINERAL WELLS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS, OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EVERETT
Authorized Official - Middle Name:C
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:940-808-1970
Mailing Address - Street 1:931 FM 1821 N
Mailing Address - Street 2:K
Mailing Address - City:MINERAL WELLS
Mailing Address - State:TX
Mailing Address - Zip Code:76067
Mailing Address - Country:US
Mailing Address - Phone:940-325-4200
Mailing Address - Fax:
Practice Address - Street 1:931 N FM 1821
Practice Address - Street 2:SUITE C
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067
Practice Address - Country:US
Practice Address - Phone:940-325-4200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-30
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty