Individual
BENNIE CLEAVELAND EVANS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
210 ADDAVALE ST, GRIFFIN, GA 30224-4217
(770) 229-1490
(770) 229-4929
Mailing address
210 ADDAVALE ST, GRIFFIN, GA 30224-4217
(770) 229-1490
(770) 229-4929
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
8495
GA
Other
Enumeration date
05/29/2015
Last updated
05/29/2015
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