Healthcare Provider Details

I. General information

NPI: 1730477738
Provider Name (Legal Business Name): LINDA AYANA VERIN DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LINDA AYANA EATON DMD

II. Dates (important events)

Enumeration Date: 07/12/2011
Last Update Date: 01/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1333 CAMINO DEL RIO S #202
SAN DIEGO CA
92108-3520
US

IV. Provider business mailing address

1333 CAMINO DEL RIO S #202
SAN DIEGO CA
92108-3520
US

V. Phone/Fax

Practice location:
  • Phone: 909-556-0869
  • Fax:
Mailing address:
  • Phone: 909-556-0869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number64133
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number10507
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: