Joseph Charles Evola, DMD

Primary specialty

DentistTaxonomy code 122300000X

License

2010022084 Issued in MO

Practice address

5650 Mexico Rd Ste 5
Saint Peters, MO 63376-1696

Phone

(636) 447-6665

NPI assigned

Dec 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO

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

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

{
    "created_epoch": "1165276800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1393891200000",
    "number": "1952469652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5650 MEXICO RD STE 5",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761696",
            "telephone_number": "248-477-3872"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5650 MEXICO RD STE 5",
            "city": "SAINT PETERS",
            "state": "MO",
            "postal_code": "633761696",
            "telephone_number": "636-447-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVOLA",
        "first_name": "JOSEPH",
        "middle_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-05",
        "last_updated": "2014-03-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "14643",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2010022084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4892532",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Abigail Elizabeth Estes, PLPC
• Jennifer L Etling, MD
• Cassandra Eubanks, LPC
• Laurie J Evans-Schoenecker, LCSW
• James Glennon Evans, D.D.S.
• Evolution MD, LLC
• Executive Centre Surgical Services
• Raymond Fada Jr., O.D.
• Romulo Joven Fajatin, MD
• Meredith Leigh Fallert, RD

• Dentist in Saint Peters, MO
• Providers in Saint Peters, MO by specialty
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; 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.