# RANDOLPH T. EVANS, D.D.S. P.L.L.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1902026479
- **Authorized official:** DR. RANDOLPH TERRY EVANS D.D.S. (OWNER)
- **Authorized official phone:** (304) 263-3131

## Contact information

- **Practice address:** 22 SIERRA DRIVE, MARTINSBURG, WV 25403-1133
- **Practice address phone:** (304) 263-3131
- **Practice address fax:** (304) 263-4493
- **Mailing address:** 22 SIERRA DRIVE, MARTINSBURG, WV 25403-1133
- **Mailing address phone:** (304) 263-3131
- **Mailing address fax:** (304) 263-4493

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 2987 | WV | Yes |
| 1223G0001X | General Practice Dentistry | 3708 | WV | — |

## Other

- **Enumeration date:** 04/26/2007
- **Last updated:** 08/22/2020