MEDICARE: DR. CATHERINE BONITA EVANS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	5011	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063479830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CATHERINE BONITA EVANS DDS

Provider Business Mailing Address
First Line	:	PO BOX 449
Second Line	:
City	:	WADE
State	:	NC
Zip	:	28395-0449
Country	:	US
Telephone Number	:	910-483-6694
Fax Number	:	910-483-2215

Provider Business Practice Location Address
First Line	:	6540 CLINTON RD
Second Line	:
City	:	STEDMAN
State	:	NC
Zip	:	28391-8846
Country	:	US
Telephone Number	:	910-483-3150
Fax Number	:	910-483-2845

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	02/19/2013

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