Provider Demographics
NPI:1295801652
Name:LEDIS, EVAN HOWARD (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:HOWARD
Last Name:LEDIS
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 1:6910 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2903
Mailing Address - Country:US
Mailing Address - Phone:561-967-7400
Mailing Address - Fax:561-967-7491
Practice Address - Street 1:6910 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2903
Practice Address - Country:US
Practice Address - Phone:561-967-7400
Practice Address - Fax:561-967-7491
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL123411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice