Eron J Evans DDS, PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D-3891 Issued in ID

Legal business name

ERON J EVANS DDS, PA

Practice address

2010 Flandro Dr
Pocatello, ID 83202-1947

Phone

(208) 238-0600

NPI assigned

Apr 25, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Eron J. Evans, DDS, PA

Title

President

Phone

(208) 238-0600

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1209081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1209081600000",
    "number": "1508031071",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2010 FLANDRO DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832021947",
            "telephone_number": "208-238-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2010 FLANDRO DR",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832021947",
            "telephone_number": "208-238-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ERON J EVANS DDS, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-25",
        "last_updated": "2008-04-25",
        "status": "A",
        "authorized_official_last_name": "EVANS",
        "authorized_official_first_name": "ERON",
        "authorized_official_middle_name": "J.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "208-238-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, PA"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D-3891",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807673600",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Pocatello, ID
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 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.