MEDICARE: DR. JOSEPH EVANS D.D.S.

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	8181	TN

General Provider Information

NPI Number	:	1619967551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH EVANS D.D.S.

Provider Business Mailing Address
First Line	:	2206 SPEDALE CT
Second Line	:	SUITE 6
City	:	SPRING HILL
State	:	TN
Zip	:	37174-6137
Country	:	US
Telephone Number	:	615-302-1414
Fax Number	:	615-302-1434

Provider Business Practice Location Address
First Line	:	2206 SPEDALE CT
Second Line	:	SUITE 6
City	:	SPRING HILL
State	:	TN
Zip	:	37174-6137
Country	:	US
Telephone Number	:	615-302-1414
Fax Number	:	615-302-1434

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

Provider Enumeration Date	:	10/23/2005
Last Update Date	:	07/08/2007

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