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General NPI Number Information
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NPI Number | 1356316202
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Entity Type | Individual
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Provider Name | LARRY D EVANS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 3550 S 4TH ST SUITE 240
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5071
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Country | US
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Telephone | 913-772-4334
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Fax | 913-772-0851
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Provider Business Mailing Address
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Address Line | 3550 S 4TH ST SUITE 240
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City | LEAVENWORTH
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State | KS
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Zip | 66048-5071
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Country | US
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Telephone | 913-772-4334
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Fax | 913-772-0851
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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 | 1223P0106X
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Taxonomy Name | Oral and Maxillofacial Pathology Dentistry
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License Number | 4672
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License Number State | KS
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