Provider Demographics
NPI:1306927892
Name:EVANS, JARED DEAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:DEAN
Last Name:EVANS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1327 N STANFORD LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-5034
Mailing Address - Country:US
Mailing Address - Phone:509-891-7070
Mailing Address - Fax:509-891-4741
Practice Address - Street 1:1327 N STANFORD LN
Practice Address - Street 2:SUITE B
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5034
Practice Address - Country:US
Practice Address - Phone:509-891-7070
Practice Address - Fax:509-891-4741
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WADE000101911223P0221X
FLDN167141223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5048236Medicaid
WA5050513Medicaid