Healthcare Provider Details

I. General information

NPI: 1770765406
Provider Name (Legal Business Name): GERALD HOLDERITH EVANS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2007
Last Update Date: 12/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 FLORIDA AVE
NEW ORLEANS LA
70119-2799
US

IV. Provider business mailing address

5121 CRAIG AVE
KENNER LA
70065-3215
US

V. Phone/Fax

Practice location:
  • Phone: 504-941-8277
  • Fax:
Mailing address:
  • Phone: 504-887-1479
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number3279
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: