Healthcare Provider Details

I. General information

NPI: 1598714594
Provider Name (Legal Business Name): WILLIAM ALBERT EVELAND III D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 02/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2435 RESEARCH PKWY SUITE 250
COLORADO SPRINGS CO
80920-1070
US

IV. Provider business mailing address

2435 RESEARCH PKWY SUITE 250
COLORADO SPRINGS CO
80920-1070
US

V. Phone/Fax

Practice location:
  • Phone: 719-487-9075
  • Fax: 719-434-4865
Mailing address:
  • Phone: 719-487-9075
  • Fax: 719-434-4865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number8462
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: