Active NPI
Forest Luke Evans, DDS
- General Practice Dentistry
- Bishopville, SC
National Provider Identifier
1295811339
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 1623
- Practice address
- 101 Harris Street,
Bishopville, SC 29010-0531 - Phone
- (803) 484-6041
- Fax
- (803) 484-6514
- NPI assigned
- Oct 31, 2006
- Reactivated
- Aug 1, 2007
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 1623 | SC | Primary |
Addresses
Primary practice location
101 Harris Street,
Bishopville, SC 29010-0531
Mailing address
PO Box 531
Bishopville, SC 29010-0531
Phone (803) 484-6041
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| Z1623-3 | Medicaid | SC |
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 |
|---|---|---|---|
| 1623 | SC | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162252800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185926400000",
"number": "1295811339",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 531",
"city": "BISHOPVILLE",
"state": "SC",
"postal_code": "290100531",
"telephone_number": "803-484-6041",
"fax_number": "803-484-6514"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "101 HARRIS STREET,",
"city": "BISHOPVILLE",
"state": "SC",
"postal_code": "290100531",
"telephone_number": "803-484-6041",
"fax_number": "803-484-6514"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "FOREST",
"middle_name": "LUKE",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-31",
"last_updated": "2007-08-01",
"deactivation_date": "2007-07-17",
"reactivation_date": "2007-08-01",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "SC",
"license": "1623",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "Z1623-3",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bishopville, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.