Organization
GLENN J EVANS DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GLENN EVANS DDS (DENTIST)
(630) 362-8674
Entity
Organization
Contact information
Practice address
703 PARKWAY DR, WHEATON, IL 60187-3646
(630) 362-8674
Mailing address
703 PARKWAY DR, WHEATON, IL 60187-3646
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019026423
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9177499
—
IL
Enumeration date
06/29/2012
Last updated
06/29/2012
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