Active NPI
Chris Evanov, DDS
- Endodontics
- Dupont, WA
National Provider Identifier
1144287822
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DE60095117
- Practice address
- 1910 Charles St
Dupont, WA 98327-7740 - Phone
- (253) 389-0987
- NPI assigned
- Apr 27, 2006
- Last updated
- Jan 15, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DE60095117 | WA | Primary |
Addresses
Primary practice location
1910 Charles St
Dupont, WA 98327-7740
Mailing address
10904 Gravelly Lake Dr SW
Lakewood, WA 98499-1330
Phone (253) 589-3636
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DE60095117 | WA | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sean L Wittmer DMD PS | Endodontics | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Endodontics
- Tacoma, WA
- NPI 1649504606
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389744000000",
"number": "1144287822",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10904 GRAVELLY LAKE DR SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984991330",
"telephone_number": "253-589-3636",
"fax_number": "253-589-3177"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1910 CHARLES ST",
"city": "DUPONT",
"state": "WA",
"postal_code": "983277740",
"telephone_number": "253-389-0987"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANOV",
"first_name": "CHRIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2014-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "WA",
"license": "DE60095117",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dupont, WA
- Dupont Pharmacy Inc (DuPont Pharmacy)
- Dupont Physical Therapy, Inc., P.S. (Dupont Physical Therapy)
- Dupont Speech & Language
- Holly Elaine Durnal
- Petra Asuncion Esparza
- Melissa Lyn Everett
- Evergreen Chiropractic Center PC (DuPont Chiropractic)
- Eye Love PLLC (Eye Love Dupont)
- Eye Physicians of Olympia Inc PS (Clarus Eye Centre DuPont)
- Lillyanna Sabra Farid
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.