MEDICARE: DR. MICHAEL THOMAS 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	11491	MD

General Provider Information

NPI Number	:	1548230121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL THOMAS EVANS DDS

Provider Business Mailing Address
First Line	:	577 STERNBERG AVE
Second Line	:	U.S. ARMY DENTAL ACTIVITY
City	:	FORT EUSTIS
State	:	VA
Zip	:	23604-1526
Country	:	US
Telephone Number	:	757-314-7944
Fax Number	:

Provider Business Practice Location Address
First Line	:	577 STERNBERG AVE
Second Line	:	U.S. ARMY DENTAL ACTIVITY
City	:	FORT EUSTIS
State	:	VA
Zip	:	23604-1526
Country	:	US
Telephone Number	:	757-314-7944
Fax Number	:

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

Provider Enumeration Date	:	01/25/2006
Last Update Date	:	03/07/2023

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