Provider Demographics
NPI:1831270396
Name:POKU-KWATENG, EVELYN (DDS)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:POKU-KWATENG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 TINLEY MILL DR
Mailing Address - Street 2:
Mailing Address - City:HAYMARKET
Mailing Address - State:VA
Mailing Address - Zip Code:20169-3281
Mailing Address - Country:US
Mailing Address - Phone:540-899-9511
Mailing Address - Fax:301-870-7034
Practice Address - Street 1:3128 COWAN BOULEVARD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22401
Practice Address - Country:US
Practice Address - Phone:540-899-9511
Practice Address - Fax:301-870-7034
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014115671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice