MEDICARE: DR. DARWIN HAROLD EVANS DMD

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	122300000X	Dentist	6133	NV
2	122300000X	Dentist	7839001-9921	UT

General Provider Information

NPI Number	:	1144529942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DARWIN HAROLD EVANS DMD

Provider Business Mailing Address
First Line	:	3896 NORTH MARTIN LUTHER KING BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-614-1792
Fax Number	:	702-933-0190

Provider Business Practice Location Address
First Line	:	3896 NORTH MARTIN LUTHER KING BLVD
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89032
Country	:	US
Telephone Number	:	702-614-1792
Fax Number	:	702-933-0190

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/18/2011
Last Update Date	:	03/18/2011

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