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NPI Code Detail

MEDICARE: DR. JARED DEAN EVANS D.M.D.

MEDICARE: DR. JARED DEAN EVANS D.M.D.
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
11223P0221XPediatric DentistryDE00010191WA
21223P0221XPediatric DentistryDN16714FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306927892
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JARED DEAN EVANS D.M.D.
Provider Business Mailing Address
First Line : 1327 N STANFORD LN
Second Line : SUITE B
City : LIBERTY LAKE
State : WA
Zip : 99019-5034
Country : US
Telephone Number : 509-891-7070
Fax Number : 509-891-4741
Provider Business Practice Location Address
First Line : 1327 N STANFORD LN
Second Line : SUITE B
City : LIBERTY LAKE
State : WA
Zip : 99019-5034
Country : US
Telephone Number : 509-891-7070
Fax Number : 509-891-4741
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2006
Last Update Date : 07/27/2012

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