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General NPI Number Information
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NPI Number | 1063854339
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Entity Type | Individual
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Provider Name | LISA MCEVOY DDS
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Gender | Female
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Dates
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Enumeration Date | 07/26/2013
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 440 E TAMPA ST
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City | SPRINGFIELD
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State | MO
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Zip | 65806
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Country | US
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Telephone | 417-851-1589
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Fax | 417-865-3479
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Provider Business Mailing Address
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Address Line | 600 CAISSON HILL RD
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City | FORT RILEY
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State | KS
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Zip | 66442-7037
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Country | US
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Telephone | 785-239-7241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 00202031
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License Number State | CO
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