Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 8383 | SC |
NPI | 1114332921 |
---|---|
Provider Name | Zachary P Evans |
First Address | Charleston, SC 29407-5768 |
Second Address | Charleston, SC 29407-5768 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2014 |
Last Update Date | 01/07/2014 |