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General NPI Number Information
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NPI Number | 1902026479
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Entity Type | Organization
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Legal Business Name | RANDOLPH T. EVANS, D.D.S. P.L.L.C.
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 22 SIERRA DRIVE
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City | MARTINSBURG
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State | WV
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Zip | 25403-1133
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Country | US
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Telephone | 304-263-3131
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Fax | 304-263-4493
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Provider Business Mailing Address
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Address Line | 22 SIERRA DRIVE
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City | MARTINSBURG
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State | WV
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Zip | 25403-1133
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Country | US
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Telephone | 304-263-3131
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Fax | 304-263-4493
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Authorized Official
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Title or Position | OWNER
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Name | DR. RANDOLPH TERRY EVANS
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Credential | D.D.S.
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Telephone | 304-263-3131
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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 | 3708
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2987
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License Number State | WV
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