MEDICARE: DR. EVAN PERKINS DDS, MS

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	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	33727	TX
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	33272	TX

General Provider Information

NPI Number	:	1447898093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EVAN PERKINS DDS, MS

Provider Business Mailing Address
First Line	:	4763 BARWICK DR STE 107
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1531
Country	:	US
Telephone Number	:	817-294-5021
Fax Number	:	817-294-9310

Provider Business Practice Location Address
First Line	:	4763 BARWICK DR STE 107
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-1531
Country	:	US
Telephone Number	:	817-294-5021
Fax Number	:	817-294-9310

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

Provider Enumeration Date	:	12/13/2019
Last Update Date	:	06/09/2022

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