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General NPI Number Information
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NPI Number | 1386736742
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Entity Type | Individual
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Provider Name | TODD MICHAEL EVANS D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1020 SOUTHAMPTON DR
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City | DECATUR
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State | IN
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Zip | 46733-1049
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Country | US
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Telephone | 260-724-8015
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Fax | 260-724-8552
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Provider Business Mailing Address
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Address Line | 14634 SOARING HAWK TRL
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City | HOAGLAND
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State | IN
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Zip | 46745-9613
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Country | US
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Telephone | 260-639-0602
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Fax | 260-724-8552
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12009752
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License Number State | IN
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