Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 0401410901 | VA |
NPI | 1053392563 |
---|---|
Provider Name | Dr. Evelyn M. Rolon |
First Address | Abingdon, VA 24211-3809 |
Second Address | Abingdon, VA 24210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 08/07/2007 |