Provider Demographics
NPI:1124336128
Name:EVANS, BRIAN EDWARDS (DDS)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:EDWARDS
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 1:5220 NEIL RD.
Mailing Address - Street 2:100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-829-7700
Mailing Address - Fax:775-829-7702
Practice Address - Street 1:5220 NEIL RD.
Practice Address - Street 2:100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-829-7700
Practice Address - Fax:775-829-7702
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV5956122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist