Provider Demographics
NPI:1063567667
Name:EVANISH, JOHN III (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:
Last Name:EVANISH
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:HC 6 BOX 6924
Mailing Address - Street 2:ROUTE 6
Mailing Address - City:HAWLEY
Mailing Address - State:PA
Mailing Address - Zip Code:18428-9002
Mailing Address - Country:US
Mailing Address - Phone:570-226-8800
Mailing Address - Fax:570-226-4939
Practice Address - Street 1:HC 6 BOX 6924
Practice Address - Street 2:ROUTE 6
Practice Address - City:HAWLEY
Practice Address - State:PA
Practice Address - Zip Code:18428-9002
Practice Address - Country:US
Practice Address - Phone:570-226-8800
Practice Address - Fax:570-226-4939
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PADS028534L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice