MEDICARE: G. BRIAN EVES, D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3218	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023395332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	G. BRIAN EVES, D.D.S.

Provider Business Mailing Address
First Line	:	PO BOX 599
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-0599
Country	:	US
Telephone Number	:	304-523-2332
Fax Number	:	304-523-0681

Provider Business Practice Location Address
First Line	:	4602 ROUTE 152
Second Line	:
City	:	LAVALETTE
State	:	WV
Zip	:	25535-9702
Country	:	US
Telephone Number	:	304-523-2332
Fax Number	:	304-523-0681

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. GARY BRIAN EVES
Credential	:	D.D.S.
Telephone Number	:	304-523-2332

Provider Enumeration Date	:	11/15/2011
Last Update Date	:	11/15/2011

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