Healthcare Provider Details

I. General information

NPI: 1053392563
Provider Name (Legal Business Name): EVELYN M. ROLON D.M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 WEST MAIN
ABINGDON VA
24210
US

IV. Provider business mailing address

363 OAKMONT DR
ABINGDON VA
24211-3809
US

V. Phone/Fax

Practice location:
  • Phone: 276-739-7942
  • Fax: 276-739-7943
Mailing address:
  • Phone: 276-739-7942
  • Fax: 276-739-7943

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number0401410901
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: