Individual
DR. KEITH ALLEN EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.S.
Contact information
Practice address
113 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 661-8900
(309) 661-8118
Mailing address
113 N REGENCY DR, BLOOMINGTON, IL 61701-3515
(309) 661-8900
(309) 661-8118
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
19-025805
IL
122300000X
Dentist
7391
NC
1223E0200X
Endodontics
Primary
021-002108
IL
Other
Enumeration date
11/15/2006
Last updated
03/12/2014
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