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General NPI Number Information
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NPI Number | 1104156017
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Entity Type | Organization
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Legal Business Name | PAUL A. EVANS, DDS
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Dates
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Enumeration Date | 12/29/2009
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Last Update Date | 12/29/2009
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Provider Practice Location Address
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Address Line | 7 W CENTER ST
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City | GREENWOOD
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State | AR
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Zip | 72936-4804
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Country | US
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Telephone | 479-996-8000
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Fax | 479-996-9000
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Provider Business Mailing Address
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Address Line | 7 W CENTER ST P.O. BOX 250
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City | GREENWOOD
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State | AR
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Zip | 72936-4804
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Country | US
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Telephone | 479-996-8000
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Fax | 479-996-9000
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. PAUL ANTHONY EVANS
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Credential |
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Telephone | 479-996-8000
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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 | 3004
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License Number State | AR
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