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General NPI Number Information
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NPI Number | 1124758131
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Entity Type | Individual
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Provider Name | EVAN MCGOWAN DDS
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Gender | Male
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Dates
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Enumeration Date | 06/13/2022
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Last Update Date | 06/13/2022
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Provider Practice Location Address
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Address Line | 1315 US HIGHWAY 2 W
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City | KALISPELL
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State | MT
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Zip | 59901-3413
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Country | US
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Telephone | 406-890-6364
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Fax |
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Provider Business Mailing Address
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Address Line | 533 LINDEN AVE
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City | GRAND ISLAND
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State | NE
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Zip | 68801-8668
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN-DEN-LIC-23662
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License Number State | MT
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