Organization
EVANS ENDODONTICS, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KEITH ALLEN EVANS D.M.D., M.S. (PRESIDENT)
(309) 661-8900
Entity
Organization
Contact information
Practice address
208 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3571
(309) 661-8900
(309) 661-8118
Mailing address
208 N WILLIAMSBURG DR, BLOOMINGTON, IL 61704-3571
(309) 661-8900
(309) 661-8118
Taxonomy
Speciality
Code
Description
License number
State
1223E0200X
Endodontics
Primary
21002108
IL
Other
Enumeration date
01/08/2008
Last updated
01/08/2008
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