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General NPI Number Information
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NPI Number | 1104443381
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Entity Type | Organization
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Legal Business Name | EVANS SIGNATURE DENTISTRY LLC
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Dates
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Enumeration Date | 07/03/2020
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Last Update Date | 02/10/2022
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Provider Practice Location Address
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Address Line | 584 BLUE RIDGE DR
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City | EVANS
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State | GA
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Zip | 30809-3604
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Country | US
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Telephone | 706-650-9700
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1670
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City | EVANS
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State | GA
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Zip | 30809-1670
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Country | US
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Telephone | 706-650-9700
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NILAY PATEL
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Credential | DMD
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Telephone | 706-650-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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