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General NPI Number Information
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NPI Number | 1609905918
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Entity Type | Organization
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Legal Business Name | JOHN J. EVOLA, DDS, INC.
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Dates
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Enumeration Date | 03/04/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3535 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3429
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Country | US
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Telephone | 419-693-0201
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Fax | 419-693-3170
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Provider Business Mailing Address
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Address Line | 3535 NAVARRE AVE
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City | OREGON
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State | OH
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Zip | 43616-3429
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Country | US
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Telephone | 419-693-0201
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Fax | 419-693-3170
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN JOSEPH EVOLA
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Credential | D.D.S.
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Telephone | 419-693-0201
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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 | OH19567
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License Number State | OH
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