Healthcare Provider Details

I. General information

NPI: 1235622218
Provider Name (Legal Business Name): AUBRIE J EVANS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2018
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2301 S HIGHWAY 65 STE 1
MARSHALL MO
65340-3713
US

IV. Provider business mailing address

2301 S HIGHWAY 65 STE 1
MARSHALL MO
65340-3713
US

V. Phone/Fax

Practice location:
  • Phone: 660-886-9500
  • Fax:
Mailing address:
  • Phone: 660-202-9593
  • Fax: 660-675-3002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number2018019129
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2018019129
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: