Provider Demographics
NPI:1730727660
Name:EVANS, LARRY BRIAN (DDS)
Entity type:Individual
Prefix:DR
First Name:LARRY
Middle Name:BRIAN
Last Name:EVANS
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 1:635 E GULF DR UNIT B102
Mailing Address - Street 2:
Mailing Address - City:SANIBEL
Mailing Address - State:FL
Mailing Address - Zip Code:33957-7121
Mailing Address - Country:US
Mailing Address - Phone:239-472-6982
Mailing Address - Fax:
Practice Address - Street 1:55 TOWLER RD
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-4717
Practice Address - Country:US
Practice Address - Phone:770-962-9560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009789122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist