Individual
DR. JOSEPH CHARLES EVOLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
5650 MEXICO RD STE 5, SAINT PETERS, MO 63376-1696
(636) 447-6665
Mailing address
5650 MEXICO RD STE 5, SAINT PETERS, MO 63376-1696
(248) 477-3872
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
14643
MI
122300000X
Dentist
Primary
2010022084
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4892532
—
MI
Enumeration date
12/05/2006
Last updated
03/04/2014
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