Healthcare Provider Details

I. General information

NPI: 1740356534
Provider Name (Legal Business Name): ERIK WILLIAM EVANS DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 02/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 PIEDMONT AVE STE. 7300
CINCINNATI OH
45219-2489
US

IV. Provider business mailing address

PO BOX 630579
CINCINNATI OH
45263-0579
US

V. Phone/Fax

Practice location:
  • Phone: 513-475-8787
  • Fax: 513-475-7348
Mailing address:
  • Phone: 513-585-5506
  • Fax: 513-585-5511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number20929
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number30.020929
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number35.087935
License Number StateOH
# 4
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number35.087935
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: