MEDICARE: EVANS DENTAL PRACTICE P.C.

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	044715	NY

General Provider Information

NPI Number	:	1760693006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EVANS DENTAL PRACTICE P.C.

Provider Business Mailing Address
First Line	:	549 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1329
Country	:	US
Telephone Number	:	718-703-8496
Fax Number	:	718-703-1521

Provider Business Practice Location Address
First Line	:	549 E 26TH ST
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11210-1329
Country	:	US
Telephone Number	:	718-703-8496
Fax Number	:	718-703-1521

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CHARMAINE ANDREA EVANS
Credential	:	DDS
Telephone Number	:	718-703-8496

Provider Enumeration Date	:	05/25/2007
Last Update Date	:	08/22/2020

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