Healthcare Provider Details

I. General information

NPI: 1699752758
Provider Name (Legal Business Name): T. WILLIAM EVANS D.D.S., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 E TOWN ST SUITE C
COLUMBUS OH
43215-4602
US

IV. Provider business mailing address

280 E TOWN ST SUITE C
COLUMBUS OH
43215-4602
US

V. Phone/Fax

Practice location:
  • Phone: 614-224-0905
  • Fax: 614-621-0906
Mailing address:
  • Phone: 614-224-0905
  • Fax: 614-621-0906

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30-01-2211
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License Number35-031770
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: