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General NPI Number Information
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NPI Number | 1740835529
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Entity Type | Individual
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Provider Name | CLORA JAMIE O'REILLY EVANS DMD
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Gender | Female
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Dates
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Enumeration Date | 08/07/2019
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 2300 N HILLS ST STE B
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City | MERIDIAN
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State | MS
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Zip | 39305-2633
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Country | US
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Telephone | 769-249-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 28 WIMBLEDON DR
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City | JACKSON
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State | MS
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Zip | 39211-2443
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Country | US
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Telephone | 601-594-9202
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D.0006692-C1
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | OR-604-21
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License Number State | MS
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