Individual
MR. KENNETH EVINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DENTIST
Contact information
Practice address
107 INDUSTRIAL DRIVE, SUITE C, LOUISBURG, NC 27549
(919) 496-8132
(919) 496-3123
Mailing address
107 INDUSTRIAL DRIVE, SUITE C, LOUISBURG, NC 27549
(919) 496-8132
(919) 496-3123
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4636
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07101
HEALTH CHOICE
NC
05
—
3404486
—
NC
01
—
81111D
PRIVATE INS
NC
Enumeration date
01/29/2007
Last updated
07/08/2007
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