Provider Demographics
NPI:1124333778
Name:EVANS, GENE WAYNE (DDS)
Entity type:Individual
Prefix:DR
First Name:GENE
Middle Name:WAYNE
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:FILLMORE
Mailing Address - State:CA
Mailing Address - Zip Code:93015-1332
Mailing Address - Country:US
Mailing Address - Phone:805-524-1313
Mailing Address - Fax:805-524-2437
Practice Address - Street 1:502 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:FILLMORE
Practice Address - State:CA
Practice Address - Zip Code:93015-1332
Practice Address - Country:US
Practice Address - Phone:805-524-1313
Practice Address - Fax:805-524-2437
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-06
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA183151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice