Provider Demographics
NPI:1285784025
Name:EVANS, MARK D (DDS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
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 1:315 LAMAR ST.
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37804-5848
Mailing Address - Country:US
Mailing Address - Phone:865-984-6191
Mailing Address - Fax:865-379-7890
Practice Address - Street 1:315 LAMAR ST.
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37804-5848
Practice Address - Country:US
Practice Address - Phone:865-984-6191
Practice Address - Fax:865-379-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS69271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice