MEDICARE: DR. LAWSON ERIC 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	35607	CA

General Provider Information

NPI Number	:	1821086836
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWSON ERIC EVANS DDS

Provider Business Mailing Address
First Line	:	1805 NOVATO BLVD
Second Line	:	#4
City	:	NOVATO
State	:	CA
Zip	:	94947-2934
Country	:	US
Telephone Number	:	415-898-0696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1805 NOVATO BLVD
Second Line	:	#4
City	:	NOVATO
State	:	CA
Zip	:	94947-2934
Country	:	US
Telephone Number	:	415-898-0696
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	07/08/2007

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