Brandon V Evert, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

019.033714 Issued in IL

Practice address

674 Blvd de France
Beaufort, SC 29905

Phone

(630) 777-5222

NPI assigned

Mar 28, 2022

Reactivated

Jul 11, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1648425600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694736000000",
    "number": "1649920109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40W066 CHADSWORTH DR",
            "city": "GENEVA",
            "state": "IL",
            "postal_code": "601345414",
            "telephone_number": "630-777-5222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "674 BLVD DE FRANCE",
            "city": "BEAUFORT",
            "state": "SC",
            "postal_code": "29905",
            "telephone_number": "630-777-5222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVERT",
        "first_name": "BRANDON",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-03-28",
        "last_updated": "2023-09-15",
        "certification_date": "2023-09-13",
        "deactivation_date": "2022-06-08",
        "reactivation_date": "2022-07-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IL",
            "license": "019.033714",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Beaufort, SC
• Providers in Beaufort, SC by specialty
• Dentist in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2023; 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.