Provider Demographics
NPI:1316508765
Name:TRAVIS EVANS DDS, PLLC
Entity type:Organization
Organization Name:TRAVIS EVANS DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRAVIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-898-3053
Mailing Address - Street 1:633 N GILBERT RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6629
Mailing Address - Country:US
Mailing Address - Phone:480-898-3053
Mailing Address - Fax:480-656-4864
Practice Address - Street 1:633 N GILBERT RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-6629
Practice Address - Country:US
Practice Address - Phone:480-898-3053
Practice Address - Fax:480-656-4864
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-26
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental