=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962301044
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GEORGE EVANS JR DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/04/2026
-----------------------------------------------------
Last Update Date | 11/04/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5415 OLD COURT RD SUITE S01
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-922-1601
-----------------------------------------------------
Fax | 410-314-4738
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5415 OLD COURT RD SUITE S01
-----------------------------------------------------
City | RANDALLSTOWN
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21133
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-922-1601
-----------------------------------------------------
Fax | 410-314-4738
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. GEORGE E EVANS JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 410-922-1601
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------