Provider Demographics
NPI:1811107295
Name:EVANS, WILLIAM E (DMD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:E
Last Name:EVANS
Suffix:
Gender:M
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:PO BOX 1466
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02331-1466
Mailing Address - Country:US
Mailing Address - Phone:617-281-3541
Mailing Address - Fax:
Practice Address - Street 1:42 CAPTAINS HILL RD
Practice Address - Street 2:
Practice Address - City:DUXBURY
Practice Address - State:MA
Practice Address - Zip Code:02332-5054
Practice Address - Country:US
Practice Address - Phone:617-281-3541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA14967122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist