Organization
GLENN J EVANS FAMILY DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN EVANS DDS (PRESIDENT)
(630) 362-8674
Entity
Organization
Contact information
Practice address
1749 S NAPERVILLE RD STE 102, WHEATON, IL 60189-5892
(630) 260-1280
(630) 260-1233
Mailing address
703 PARKWAY DR, WHEATON, IL 60187-3646
(630) 362-8674
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538142492
—
IL
Enumeration date
03/01/2022
Last updated
03/01/2022
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