Healthcare Provider Details

I. General information

NPI: 1083160741
Provider Name (Legal Business Name): JOSHUA DANIEL EVANS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 09/14/2025
Certification Date: 09/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

H200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

PSC 475 BOX 1
FPO AP
96350-1200
US

V. Phone/Fax

Practice location:
  • Phone: 760-719-4747
  • Fax:
Mailing address:
  • Phone: 315-243-8658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12012486A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number12012486A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: