Evans, Brock D.

Evans, Brock D. is an individual health care provider with primary practice located at 1505 E Lamar Alexander Pkwy , Maryville TN 37804-5131. He recently has only one registered license in Dental Providers / Oral and Maxillofacial Surgery, which is considered as his primary health care specialty. Evans, Brock D. can be contacted via phone (865) 983-8630.

Contact Information

Primary practice address
1505 E Lamar Alexander Pkwy Maryville TN 37804-5131
Phone: (865) 983-8630
Fax: (865) 981-4914
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Oral and Maxillofacial Surgery 1223S0112X DS8807 Tennessee

Profile Details

NPI number 1073785010
LBN Legal business name Evans, Brock D.
Credentials Doctor of Dental Medicine (DMD)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2008
Last updated Aug 10th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073785010 NPPES
Tennessee Other 8807 LICENSE
Tennessee MEDICAID 5442224 LICENSE

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