Provider Demographics
NPI:1811093081
Name:EVANS, L. CORY (DMD)
Entity type:Individual
Prefix:
First Name:L.
Middle Name:CORY
Last Name:EVANS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3640 SOUTH HIGHLAND DR.
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106
Mailing Address - Country:US
Mailing Address - Phone:801-278-9911
Mailing Address - Fax:801-278-9913
Practice Address - Street 1:3640 SOUTH HIGHLAND DR.
Practice Address - Street 2:SUITE 6
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84106
Practice Address - Country:US
Practice Address - Phone:801-278-9911
Practice Address - Fax:801-278-9913
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT89-144422-99231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice