Individual
DR. EVAN BLACKWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
2911 A W GRIMES BLVD STE 106, PFLUGERVILLE, TX 78660-5459
(512) 337-2578
Mailing address
10430 MORADO CIR APT 2030, AUSTIN, TX 78759-5669
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
32883
TX
122300000X
Dentist
D10343
OR
1223P0300X
Periodontics
Primary
32883
TX
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/29/2014
Last updated
07/27/2023
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