Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | DD033083 | CA |
NPI | 1003021494 |
---|---|
Provider Name | Dr. Rosemary Evans |
First Address | Dos Palos, CA 93620 |
Second Address | San Jose, CA 95148 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
033083CA | DELTA DENTAL (01) |