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General NPI Number Information
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NPI Number | 1689751927
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Entity Type | Organization
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Legal Business Name | LARGOZA DENTAL CORPORATION
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/29/2008
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Provider Practice Location Address
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Address Line | 1782 TUOLUMNE ST
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City | VALLEJO
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State | CA
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Zip | 94589
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Country | US
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Telephone | 707-552-8668
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Fax | 707-552-8052
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Provider Business Mailing Address
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Address Line | 1782 TUOLUMNE ST
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City | VALLEJO
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State | CA
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Zip | 94589
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Country | US
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Telephone | 707-552-8668
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Fax | 707-552-8052
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Authorized Official
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Title or Position | DENTIST
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Name | DR. EVA MARIE Z LARGOZA
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Credential | DDS
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Telephone | 707-552-8668
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 50299
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License Number State | CA
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