Provider Demographics
NPI:1215083142
Name:EVANS, GREGORY DEAN (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:DEAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS
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Mailing Address - Street 1:3221 EASTBROOK DRIVE,
Mailing Address - Street 2:BUILDING A SUITE 101
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525
Mailing Address - Country:US
Mailing Address - Phone:970-407-1020
Mailing Address - Fax:970-266-8238
Practice Address - Street 1:3221 EASTBROOK DR
Practice Address - Street 2:A-101
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525
Practice Address - Country:US
Practice Address - Phone:970-407-1020
Practice Address - Fax:970-266-8238
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2016-04-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CO76791223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO02076792Medicaid