Provider Demographics
NPI:1124340781
Name:EVVARD, MARTIN RICHARD (DMD)
Entity type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:RICHARD
Last Name:EVVARD
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 WAKEFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03867-1958
Mailing Address - Country:US
Mailing Address - Phone:603-332-1796
Mailing Address - Fax:603-332-1796
Practice Address - Street 1:18 WAKEFIELD ST
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03867-1958
Practice Address - Country:US
Practice Address - Phone:603-332-1796
Practice Address - Fax:603-332-1796
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-24
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH16421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice