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General NPI Number Information
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NPI Number | 1013933647
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Entity Type | Organization
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Legal Business Name | EVELYN G. CARLOS DMD INC.
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 5824 WISH AVE
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City | ENCINO
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State | CA
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Zip | 91316-1458
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Country | US
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Telephone | 818-551-9664
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Fax |
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Provider Business Mailing Address
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Address Line | 5824 WISH AVE
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City | ENCINO
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State | CA
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Zip | 91316-1458
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Country | US
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Telephone | 818-551-9664
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. EVELYN G. CARLOS
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Credential | D.M.D.
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Telephone | 818-551-9664
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 31583
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License Number State | CA
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