Healthcare Provider Details

I. General information

NPI: 1336148857
Provider Name (Legal Business Name): DOUGLAS BRIAN EVANS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7560 RANGEWOOD DR SUITE 310
COLORADO SPRINGS CO
80920-4199
US

IV. Provider business mailing address

7560 RANGEWOOD DR SUITE 310
COLORADO SPRINGS CO
80920-4199
US

V. Phone/Fax

Practice location:
  • Phone: 719-388-1818
  • Fax: 719-388-1815
Mailing address:
  • Phone: 719-388-1818
  • Fax: 719-388-1815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8050
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: