Dr. Brian David Evans
Oral and Maxillofacial Surgeon
Uss Carl Vinson Cvn70 Unit 1000111 Box 1770
New Island City
, New Island 96629
Dr. Brian David Evans
Oral and Maxillofacial Surgeon
Uss Carl Vinson Cvn70 Unit 1000111 Box 1770
New Island City
, New Island 96629
(208) 757-0787
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About
Features
Specialties
- Oral and Maxillofacial Surgeon
Languages spoken
- English
Location
First Address
- Dr. Brian David Evans
- 4796 Panorama Dr
- San Diego, CA
- Zip : 92116-1239
- Phone : (208) 757-0787
Second Address
- Dr. Brian David Evans
- Uss Carl Vinson Cvn70 Unit 1000111 Box 1770
- Fpo, AP
- Zip : 96629
- Phone : (619) 545-4814
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| Y | 1223S0112X | Oral and Maxillofacial Surgeon | 61230 | CA |
National Provider Identifier
| NPI | 1114229317 |
|---|---|
| Provider Name | Dr. Brian David Evans |
| First Address | San Diego, CA 92116-1239 |
| Second Address | Fpo, AP 96629 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | Yes |
| Is Organization Subpart | N/A |
| Enumeration Date | 22/11/2010 |
| Last Update Date | 17/03/2018 |
Additional Identifiers
| IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
|---|---|---|
| 61230 | DENTAL LICENSE (01) | CA |
| FE7068201 | DEA (01) | |
| GA1863 | GENERAL ANESTHESIA PERMIT (01) |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.