MEDICARE: NICHOLAS 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	1223P0221X	Pediatric Dentistry	22DI03021100	NJ
2	1223P0221X	Pediatric Dentistry	DEN.00205825	CO

General Provider Information

NPI Number	:	1922747849
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS EVANS DDS

Provider Business Mailing Address
First Line	:	440 NEWCASTLE ST
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91361-1338
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5430 E WOODMEN RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8067
Country	:	US
Telephone Number	:	719-424-4668
Fax Number	:

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

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	03/06/2025

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Directions to “ NICHOLAS EVANS DDS” Practice Location

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