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NPI Code Detail

MEDICARE: L. CORY EVANS D.M.D.

MEDICARE:   L. CORY 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
11223G0001XGeneral Practice Dentistry89-144422-9923UT

General Provider Information

NPI Number : 1811093081
Entity Type Code : Individual
Provider Name (Legal Business Name) : L. CORY EVANS D.M.D.
Provider Business Mailing Address
First Line : 3640 SOUTH HIGHLAND DR.
Second Line : SUITE 6
City : SALT LAKE CITY
State : UT
Zip : 84106
Country : US
Telephone Number : 801-278-9911
Fax Number : 801-278-9913
Provider Business Practice Location Address
First Line : 3640 SOUTH HIGHLAND DR.
Second Line : SUITE 6
City : SALT LAKE CITY
State : UT
Zip : 84106
Country : US
Telephone Number : 801-278-9911
Fax Number : 801-278-9913
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/15/2006
Last Update Date : 06/08/2022

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Directions to “ L. CORY EVANS D.M.D.” Practice Location

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