1003021494 NPI number — DR. ROSEMARY EVANS DDS

Table of content: DR. ROSEMARY EVANS DDS (NPI 1003021494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003021494 NPI number — DR. ROSEMARY EVANS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EVANS
Provider First Name:
ROSEMARY
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003021494
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
46096 VALENA STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DOS PALOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-391-9501
Provider Business Mailing Address Fax Number:
209-392-1378

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2680 S WHITE ROAD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95148
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-531-9881
Provider Business Practice Location Address Fax Number:
408-531-9580
Provider Enumeration Date:
05/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  DD033083 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 033083CA . This is a "DELTA DENTAL" identifier . This identifiers is of the category "OTHER".




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