Organization
ERON J EVANS DDS, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ERON J. EVANS DDS, PA (PRESIDENT)
(208) 238-0600
Entity
Organization
Contact information
Practice address
2010 FLANDRO DR, POCATELLO, ID 83202-1947
(208) 238-0600
Mailing address
2010 FLANDRO DR, POCATELLO, ID 83202-1947
(208) 238-0600
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-3891
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
807673600
—
ID
Enumeration date
04/25/2008
Last updated
04/25/2008
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