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Individual
MR. KENNETH EVINS
Active
Individual
MR. KENNETH EVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTIST
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4636
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07101
HEALTH CHOICE
NC
05
—
3404486
—
NC
01
—
81111D
PRIVATE INS
NC
Enumeration date
01/29/2007
Last updated
07/08/2007
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