Provider Demographics
NPI:1811064595
Name:EVANS, EAGER (DDS)
Entity type:Individual
Prefix:DR
First Name:EAGER
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLUMAS ST
Mailing Address - Street 2:STE 400
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3453
Mailing Address - Country:US
Mailing Address - Phone:530-671-2630
Mailing Address - Fax:
Practice Address - Street 1:1215 PLUMAS ST
Practice Address - Street 2:STE 400
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3453
Practice Address - Country:US
Practice Address - Phone:530-671-2630
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS52777122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA52777OtherDENTAL LICENSE