Healthcare Provider Details

I. General information

NPI: 1699938662
Provider Name (Legal Business Name): DANIEL KEITH EVANS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

199 HWY 50
PECOS NM
87552
US

IV. Provider business mailing address

PO BOX 710
PECOS NM
87552-0710
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-6666
  • Fax: 505-757-2700
Mailing address:
  • Phone: 505-757-6666
  • Fax: 505-757-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDD2971
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: