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Organization
FAMILY DENTAL GROUP OF GREENVILLE PLLC
Active
Organization
FAMILY DENTAL GROUP OF GREENVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY RANDALL EVANS DDS (MEMBER)
(903) 454-0918
Entity
Organization
Contact information
Practice address
4319 RIDGECREST RD, GREENVILLE, TX 75402-6004
(903) 454-0918
(903) 454-0311
Mailing address
4319 RIDGECREST RD, GREENVILLE, TX 75402-6004
(903) 454-0918
(903) 454-0311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11800
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1223G0001X
—
TX
Enumeration date
03/20/2017
Last updated
03/20/2017
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