Individual
DR. MARK EVANS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1601 12TH AVE RD, NAMPA, ID 83686-7711
(208) 467-9690
Mailing address
1601 12TH AVE RD, NAMPA, ID 83686-7711
(208) 467-9690
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
D-4758
ID
Other
Enumeration date
06/15/2016
Last updated
12/22/2016
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