Glenn Evans, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

0401414899 Issued in VA

Practice address

1151 E Main St
Suite a
Radford, VA 24141-1761

Phone

(540) 639-1674

Fax

(640) 639-9205

NPI assigned

Jun 19, 2015

Last updated

Jun 19, 2015By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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.

• Impact Family Dental PLLC

  • General Practice Dentistry
  • Blacksburg, VA
  • NPI 1679378426
  NPD Authorized official
• Radford Family Dental, Inc.

  • General Practice Dentistry
  • Radford, VA
  • NPI 1396815080
  NPD (past)

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

{
    "created_epoch": "1434672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1434672000000",
    "number": "1235511882",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1151 E MAIN ST",
            "address_2": "SUITE A",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411761",
            "telephone_number": "540-639-1674",
            "fax_number": "640-639-9205"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1151 E MAIN ST",
            "address_2": "SUITE A",
            "city": "RADFORD",
            "state": "VA",
            "postal_code": "241411761",
            "telephone_number": "540-639-1674",
            "fax_number": "640-639-9205"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "GLENN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-06-19",
        "last_updated": "2015-06-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "VA",
            "license": "0401414899",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Drehoff, PT, DPT
• Neil P Dubner, MD
• Rebecca E Dunn, SUPERVISEE IN SOCIAL
• Dva Renal Healthcare Inc (Radford Dialysis)
• Elder Care Answers, LLC (EC Answers)
• Excel Prosthetics & Orthotics Inc (Hanger Clinic)
• Nathan Andrew Falconnier, PHARMD
• Family Health Clinic, Inc.
• Family Preservation Services, Inc
• FC of Virginia Inc (Intrepid USA Healthcare Services)

• Dentist in Radford, VA
• Providers in Radford, VA by specialty
• Dentist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.