Provider Demographics
NPI:1912917246
Name:R DEAN EVANS DDS PC
Entity Type:Organization
Organization Name:R DEAN EVANS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:276-322-2212
Mailing Address - Street 1:2201 COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-2004
Mailing Address - Country:US
Mailing Address - Phone:276-322-2212
Mailing Address - Fax:276-322-0032
Practice Address - Street 1:2201 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-2004
Practice Address - Country:US
Practice Address - Phone:276-322-2212
Practice Address - Fax:276-322-0032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010080421223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty