Provider Demographics
NPI:1316114580
Name:ALAN B. EVANS D.D.S., P.C.
Entity type:Organization
Organization Name:ALAN B. EVANS D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:BLAKE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:563-264-1180
Mailing Address - Street 1:1612 PLAZA PL
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-5364
Mailing Address - Country:US
Mailing Address - Phone:563-264-1180
Mailing Address - Fax:563-288-2776
Practice Address - Street 1:1612 PLAZA PL
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5364
Practice Address - Country:US
Practice Address - Phone:563-264-1180
Practice Address - Fax:563-288-2776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2191080Medicaid
1472182OtherUNITED CONCORDIA