Provider Demographics
NPI:1982898482
Name:EVANS, MARIANNA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARIANNA
Other - Middle Name:
Other - Last Name:KLYMUK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:703 PRITCHARD PL
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3034
Mailing Address - Country:US
Mailing Address - Phone:610-209-9488
Mailing Address - Fax:
Practice Address - Street 1:3855 W CHESTER PIKE
Practice Address - Street 2:SUITE 225
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-2304
Practice Address - Country:US
Practice Address - Phone:610-209-9488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-28
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0368301223X0400X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223P0300XDental ProvidersDentistPeriodontics