Provider Demographics
NPI:1386084564
Name:EVANS, SONJA R (DMD)
Entity type:Individual
Prefix:DR
First Name:SONJA
Middle Name:R
Last Name:EVANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 COYLE ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-1628
Mailing Address - Country:US
Mailing Address - Phone:207-772-7431
Mailing Address - Fax:
Practice Address - Street 1:82 COYLE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-1628
Practice Address - Country:US
Practice Address - Phone:207-772-7431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MERES791223G0001X
MEDEN43221223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics
No1223G0001XDental ProvidersDentistGeneral Practice