Organization
EVANS DENTAL PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK EVANS DMD (DENTIST/OWNER)
(208) 647-4441
Entity
Organization
Contact information
Practice address
1308 BENNETT AVE, BURLEY, ID 83318-2665
(208) 647-4441
Mailing address
1308 BENNETT AVE, BURLEY, ID 83318-2665
(208) 647-4441
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33733
—
ID
Enumeration date
11/26/2018
Last updated
11/26/2018
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