Provider Demographics
NPI:1124056676
Name:EVANS, CAROL BETH (DDS)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:BETH
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1227
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-1227
Mailing Address - Country:US
Mailing Address - Phone:512-295-9925
Mailing Address - Fax:512-295-5855
Practice Address - Street 1:108 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-3375
Practice Address - Country:US
Practice Address - Phone:512-295-9925
Practice Address - Fax:512-295-5855
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX193851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice