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General NPI Number Information
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NPI Number | 1437533684
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Entity Type | Organization
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Legal Business Name | BEAUMONT DENTAL PLLC
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Dates
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Enumeration Date | 07/17/2015
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Last Update Date | 07/17/2015
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Provider Practice Location Address
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Address Line | 4400 HIGHLAND AVE
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City | BEAUMONT
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State | TX
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Zip | 77705-5205
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Country | US
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Telephone | 409-813-1702
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 674330
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City | DALLAS
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State | TX
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Zip | 75267-4330
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Country | US
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Telephone | 940-808-1970
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Fax | 855-731-5147
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Authorized Official
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Title or Position | OWNER, DDS
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Name | DR. EVERETT C EVANS
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Credential | DDS
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Telephone | 940-808-1970
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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 | 23695
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License Number State | TX
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