Provider Demographics
NPI:1306907530
Name:HART, EVAN ANDREW (DMD)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:ANDREW
Last Name:HART
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 1:1667 COCHRANE CIR BLDG 7495
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4603
Mailing Address - Country:US
Mailing Address - Phone:719-526-5537
Mailing Address - Fax:
Practice Address - Street 1:1631 WETZEL AVENUE, BLDG 815
Practice Address - Street 2:US ARMY DENTAL ACTIVITY, ATTN CREDENTIALS OFFICE
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913
Practice Address - Country:US
Practice Address - Phone:719-526-5537
Practice Address - Fax:719-526-5551
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049231-11223G0001X
CT0088861223G0001X
CODEN-106691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice