Evans Endodontics, P.C.

Primary specialty

EndodonticsTaxonomy code 1223E0200X

License

21002108 Issued in IL

Legal business name

EVANS ENDODONTICS, P.C.

Practice address

208 N Williamsburg Dr
Bloomington, IL 61704-3571

Phone

(309) 661-8900

Fax

(309) 661-8118

NPI assigned

Jan 8, 2008

Last updated

Jan 8, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Keith Allen Evans, D.M.D., M.S.NPI 1215009923

Title

President

Phone

(309) 661-8900

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Keith Allen Evans, D.M.D., M.S.

  • Endodontics
  • Bloomington, IL
  • NPI 1215009923
  Authorized official Same address or phone

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

{
    "created_epoch": "1199750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1199750400000",
    "number": "1245415348",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "208 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043571",
            "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": "208 N WILLIAMSBURG DR",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617043571",
            "telephone_number": "309-661-8900",
            "fax_number": "309-661-8118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVANS ENDODONTICS, P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-01-08",
        "last_updated": "2008-01-08",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "KEITH",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "309-661-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D., M.S."
    },
    "taxonomies": [
        {
            "code": "1223E0200X",
            "taxonomy_group": "",
            "desc": "Dentist, Endodontics",
            "state": "IL",
            "license": "21002108",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bettina Ervin-Rodgers
• Morgan Erwin, FAMILY NURSE PRACTIT
• John Stephen Esch, M.D.
• Cristina Esposito, DC
• Shyann Etnier
• Kristin Evans Techmanski, MS CCC/SLP
• Donna J Evans, M.A., CCC-SLP/L
• Elizabeth L Evans
• Keith Allen Evans, D.M.D., M.S.
• Lakeshia Evans

• 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 Jan 8, 2008; 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.