Individual
GLENN EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1151 E MAIN ST, SUITE A, RADFORD, VA 24141-1761
(540) 639-1674
(640) 639-9205
Mailing address
1151 E MAIN ST, SUITE A, RADFORD, VA 24141-1761
(540) 639-1674
(640) 639-9205
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401414899
VA
Other
Enumeration date
06/19/2015
Last updated
06/19/2015
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