Provider Demographics
NPI:1740835529
Name:EVANS, CLORA JAMIE O'REILLY (DMD)
Entity type:Individual
Prefix:DR
First Name:CLORA
Middle Name:JAMIE O'REILLY
Last Name:EVANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WIMBLEDON DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211-2443
Mailing Address - Country:US
Mailing Address - Phone:601-594-9202
Mailing Address - Fax:
Practice Address - Street 1:2300 N HILLS ST STE B
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2633
Practice Address - Country:US
Practice Address - Phone:769-249-0001
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-07
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALD.0006692-C11223G0001X
MSOR-604-211223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice