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General NPI Number Information
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NPI Number | 1215337951
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Entity Type | Organization
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Legal Business Name | SALLY A. EVANS DMD PC
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Dates
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Enumeration Date | 08/31/2014
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Last Update Date | 08/31/2014
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Provider Practice Location Address
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Address Line | 819 THOMPSON BRIDGE RD
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City | GAINESVILLE
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State | GA
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Zip | 30501-1774
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Country | US
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Telephone | 770-535-8900
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Fax | 770-535-8108
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Provider Business Mailing Address
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Address Line | 819 THOMPSON BRIDGE RD
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City | GAINESVILLE
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State | GA
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Zip | 30501-1774
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Country | US
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Telephone | 770-535-8900
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Fax | 770-535-8108
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Authorized Official
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Title or Position | OWNER
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Name | SALLY EVANS
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Credential | DMD
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Telephone | 407-340-4304
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DNO13552
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License Number State | GA
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