Healthcare Provider Details

I. General information

NPI: 1285067983
Provider Name (Legal Business Name): CHRISTOPHER N EVANS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2013
Last Update Date: 08/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY DENTAL ACTIVITY BAVARIA UNIT 28038
APO AE
09112
US

IV. Provider business mailing address

US ARMY DENTAL ACTIVITY BAVARIA UNIT 28038
APO AE
09112
US

V. Phone/Fax

Practice location:
  • Phone: 314-476-4738
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number86892909922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: