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General NPI Number Information
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NPI Number | 1386172450
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Entity Type | Organization
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Legal Business Name | RICHARD C. EVANGELISTA D.D.S., INC.
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Dates
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Enumeration Date | 06/01/2017
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Last Update Date | 06/01/2017
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Provider Practice Location Address
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Address Line | 6111 JOHNSON CT STE 201
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City | PLEASANTON
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State | CA
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Zip | 94588-3331
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Country | US
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Telephone | 925-924-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 6111 JOHNSON CT STE 201
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City | PLEASANTON
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State | CA
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Zip | 94588-3331
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Country | US
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Telephone | 925-924-9900
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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. RICHARD EVANGELISTA
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Credential | DDS
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Telephone | 925-789-0575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 47258
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License Number State | CA
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