Provider Demographics
NPI:1861558652
Name:SHORT, EVAN J (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:J
Last Name:SHORT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3996 RED CEDAR DR UNIT A3
Mailing Address - Street 2:
Mailing Address - City:HIGHLANDS RANCH
Mailing Address - State:CO
Mailing Address - Zip Code:80126-8066
Mailing Address - Country:US
Mailing Address - Phone:303-470-9696
Mailing Address - Fax:216-584-1364
Practice Address - Street 1:760 BELOIT RD
Practice Address - Street 2:
Practice Address - City:BELVIDERE
Practice Address - State:IL
Practice Address - Zip Code:61008-1745
Practice Address - Country:US
Practice Address - Phone:815-547-5151
Practice Address - Fax:815-547-5336
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202905122300000X, 1223G0001X
AZ70231223G0001X
IL019034032122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice