Provider Demographics
NPI:1447898093
Name:PERKINS, EVAN (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:
Last Name:PERKINS
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4763 BARWICK DR STE 107
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76132-1531
Mailing Address - Country:US
Mailing Address - Phone:817-294-5021
Mailing Address - Fax:817-294-9310
Practice Address - Street 1:4763 BARWICK DR STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1531
Practice Address - Country:US
Practice Address - Phone:817-294-5021
Practice Address - Fax:817-294-9310
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX337271223X0400X
TX332721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics