Healthcare Provider Details

I. General information

NPI: 1316102015
Provider Name (Legal Business Name): JEFFREY BAIRD EVANS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2008
Last Update Date: 06/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 N. CEDAR AVE. SUITE 105
FRESNO CA
93720
US

IV. Provider business mailing address

7525 N. CEDAR AVE. SUITE 105
FRESNO CA
93720
US

V. Phone/Fax

Practice location:
  • Phone: 559-439-6600
  • Fax: 559-439-5400
Mailing address:
  • Phone: 559-439-6600
  • Fax: 559-439-5400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number59512
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: