Individual
DR. BROCK D. EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1505 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 983-8630
(865) 981-4914
Mailing address
1505 E LAMAR ALEXANDER PKWY, MARYVILLE, TN 37804-5131
(865) 983-8630
(865) 981-4914
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
DS8807
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5442224
—
TN
01
—
8807
LICENSE
TN
Enumeration date
03/31/2008
Last updated
08/10/2012
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