| Evans Dental Pa | |
|
1308 Bennett Ave Burley ID 83318-2665 | |
| (208) 647-4441 | |
| Not Available |
| Full Name | Evans Dental Pa |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 1308 Bennett Ave, Burley, Idaho |
| Authorized Official Name and Position | Mark Evans (DENTIST/OWNER) |
| Authorized Official Contact | 2086474441 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evans Dental Pa 1308 Bennett Ave Burley ID 83318-2665 Ph: (208) 647-4441 | Evans Dental Pa 1308 Bennett Ave Burley ID 83318-2665 Ph: (208) 647-4441 |
| NPI Number | 1205306941 |
|---|---|
| Provider Enumeration Date | 11/26/2018 |
| Last Update Date | 11/26/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205306941 | NPI | - | NPPES |
| 33733 | Medicaid | ID |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
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