Organization
FAMILY DENTAL GROUP OF GREENVILLE PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY RANDALL EVANS DDS (MEMBER)
(903) 454-0918
Entity
Organization
Contact information
Practice address
4319 RIDGECREST RD, GREENVILLE, TX 75402-6004
(903) 454-0918
(903) 454-0311
Mailing address
4319 RIDGECREST RD, GREENVILLE, TX 75402-6004
(903) 454-0918
(903) 454-0311
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
11800
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1223G0001X
—
TX
Enumeration date
03/20/2017
Last updated
03/20/2017
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