Keith Allen Evans, D.M.D., M.S.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

021-002108 Issued in IL

Practice address

113 N Regency Dr
Bloomington, IL 61701-3515

Phone

(309) 661-8900

Fax

(309) 661-8118

NPI assigned

Nov 15, 2006

Last updated

Mar 12, 2014By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

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.

• Evans Endodontics, P.C.

  • Endodontics
  • Bloomington, IL
  • NPI 1245415348
  Authorized official Same address or phone
• Endodontists of Illinois

  • Endodontics
  • Bloomington, IL
  • NPI 1396164398
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394582400000",
    "number": "1215009923",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 N REGENCY DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013515",
            "telephone_number": "309-661-8900",
            "fax_number": "309-661-8118"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 N REGENCY DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013515",
            "telephone_number": "309-661-8900",
            "fax_number": "309-661-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "KEITH",
        "middle_name": "ALLEN",
        "name_prefix": "Dr.",
        "credential": "D.M.D., M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2014-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "19-025805",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NC",
            "license": "7391",
            "primary": false
        },
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "021-002108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shyann Etnier
• Evans Endodontics, P.C.
• Kristin Evans Techmanski, MS CCC/SLP
• Donna J Evans, M.A., CCC-SLP/L
• Elizabeth L Evans
• Lakeshia Evans
• Rebecca Evans, MSOT, OTR/L
• Yvette Evans, SLP
• Everside Health, LLC (Marathon Health, Bloomington IL- E Empire St)
• Eye Surgical Associates SC

• Endodontics in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Endodontics in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 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.

Verify at the official NPI Registry.