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General NPI Number Information
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NPI Number | 1689731192
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Entity Type | Organization
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Legal Business Name | MARIUS A EVANS DDS PC
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 03/27/2014
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Provider Practice Location Address
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Address Line | 9911 KENNERLY RD SUITE G
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City | ST LOUIS
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State | MO
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Zip | 63128
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Country | US
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Telephone | 314-849-0999
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Fax | 314-849-1385
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Provider Business Mailing Address
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Address Line | 9911 KENNERLY RD SUITE G
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City | ST LOUIS
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State | MO
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Zip | 63128
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Country | US
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Telephone | 314-849-0999
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Fax | 314-849-1385
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MARIUS A EVANS
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Credential | DDS
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Telephone | 314-849-0999
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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 | DE015685
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License Number State | MO
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