Healthcare Provider Details

I. General information

NPI: 1174447130
Provider Name (Legal Business Name): EVO ENDODONTICS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2120 PRAIRIE DR STE 1001
PROSPER TX
75078-4152
US

IV. Provider business mailing address

5750 COTTON GIN RD APT 2166
FRISCO TX
75034-0449
US

V. Phone/Fax

Practice location:
  • Phone: 469-897-5545
  • Fax:
Mailing address:
  • Phone: 215-350-3330
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: EUNJUNG JI
Title or Position: ENDODONTIST
Credential: DMD
Phone: 215-350-3330