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General NPI Number Information
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NPI Number | 1689502247
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Entity Type | Organization
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Legal Business Name | EVANGELISTA DENTAL GROUP PACIFICA, PC
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Dates
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Enumeration Date | 05/12/2026
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Last Update Date | 05/12/2026
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Provider Practice Location Address
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Address Line | 205 ROCKAWAY BEACH AVE STE 8
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City | PACIFICA
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State | CA
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Zip | 94044-3269
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Country | US
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Telephone | 650-355-3126
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Fax |
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Provider Business Mailing Address
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Address Line | 205 ROCKAWAY BEACH AVE STE 8
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City | PACIFICA
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State | CA
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Zip | 94044-3269
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PAYOR CONTRACTING
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Name | CASEY CASTLE
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Credential |
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Telephone | 912-732-1504
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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 |
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License Number State |
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