Provider Demographics
NPI:1912021379
Name:EVANS, PAUL LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEWIS
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 1:563 BRUNSWICK RD.
Mailing Address - Street 2:#1
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945
Mailing Address - Country:US
Mailing Address - Phone:530-273-4442
Mailing Address - Fax:530-272-3042
Practice Address - Street 1:563 BRUNSWICK RD.
Practice Address - Street 2:#1
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945
Practice Address - Country:US
Practice Address - Phone:530-273-4442
Practice Address - Fax:530-272-3042
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51575122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist