Healthcare Provider Details

I. General information

NPI: 1871807172
Provider Name (Legal Business Name): DAVID T. EVANS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2010
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 NW 50TH ST
OKLAHOMA CITY OK
73122-5100
US

IV. Provider business mailing address

5818 NW 50TH ST
OKLAHOMA CITY OK
73122-5100
US

V. Phone/Fax

Practice location:
  • Phone: 801-201-8396
  • Fax: 215-707-0083
Mailing address:
  • Phone: 801-201-8396
  • Fax: 215-707-0083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number6252
License Number StateOK
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberPA DS 038484
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: