Healthcare Provider Details

I. General information

NPI: 1861382020
Provider Name (Legal Business Name): EVELYN AVALOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 S EASTERN AVE STE 104
LAS VEGAS NV
89123-1508
US

IV. Provider business mailing address

1001 SHADOW LN
LAS VEGAS NV
89106-4124
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-2381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8440
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: