Basic Information
| Provider Information | |||||||||
| NPI: | 1306907530 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HART | ||||||||
| FirstName: | EVAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1631 WETZEL AVENUE, BLDG 815 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY, ATTN CREDENTIALS OFFICE | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195265537 | ||||||||
| FaxNumber: | 7195265551 | ||||||||
| Practice Location | |||||||||
| Address1: | 1631 WETZEL AVENUE, BLDG 815 | ||||||||
| Address2: | US ARMY DENTAL ACTIVITY, ATTN CREDENTIALS OFFICE | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 80913 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195265537 | ||||||||
| FaxNumber: | 7195265551 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2006 | ||||||||
| LastUpdateDate: | 03/27/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DEN-10669 | CO | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 049231-1 | NY | N | Dental Providers | Dentist | General Practice | 1223G0001X | 008886 | CT | N | Dental Providers | Dentist | General Practice |
No ID Information.