MEDICARE: DR. EVETTE RANSAW BS, MS, DDS

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	DN123418	GA
2	390200000X	Student in an Organized Health Care Education/Training Program
3	122300000X	Dentist	D.007312-C1	AL

General Provider Information

NPI Number	:	1659125177
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVETTE RANSAW BS, MS, DDS

Provider Business Mailing Address
First Line	:	409 ARROWHEAD DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-4144
Country	:	US
Telephone Number	:	334-324-2819
Fax Number	:

Provider Business Practice Location Address
First Line	:	3732 US HIGHWAY 431 N
Second Line	:
City	:	PHENIX CITY
State	:	AL
Zip	:	36867-2362
Country	:	US
Telephone Number	:	334-408-3467
Fax Number	:

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

Provider Enumeration Date	:	04/11/2024
Last Update Date	:	06/04/2024

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