Provider Demographics
NPI:1538375241
Name:EVANSON, JUSTIN E (MD, DDS)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:E
Last Name:EVANSON
Suffix:
Gender:M
Credentials:MD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1960 LOCUST ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-1634
Mailing Address - Country:US
Mailing Address - Phone:214-957-4765
Mailing Address - Fax:
Practice Address - Street 1:1960 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-1634
Practice Address - Country:US
Practice Address - Phone:214-957-4765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO501941223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery