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General NPI Number Information
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NPI Number | 1093799009
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Entity Type | Individual
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Provider Name | CLINTON WILKINSON EVANS M.D., D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 12/02/2005
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 216 HEALTHWEST DR
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City | DOTHAN
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State | AL
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Zip | 36303-1942
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Country | US
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Telephone | 334-792-1158
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Fax | 334-702-6983
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Provider Business Mailing Address
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Address Line | 35 HAMPTON WAY
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City | DOTHAN
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State | AL
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Zip | 36305-6319
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Country | US
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Telephone | 334-792-1158
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Fax | 334-702-6983
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 22785
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 4563
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License Number State | AL
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