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General NPI Number Information
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NPI Number | 1851476766
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Entity Type | Organization
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Legal Business Name | JAIME V. EVANGELISTA JR, D.M.D, INC.
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 24901 SANTA CLARA ST SUITE B-2
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City | HAYWARD
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State | CA
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Zip | 94544-2147
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Country | US
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Telephone | 510-887-6835
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Fax | 510-887-2872
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Provider Business Mailing Address
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Address Line | 24901 SANTA CLARA ST SUITE B-2
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City | HAYWARD
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State | CA
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Zip | 94544-2147
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Country | US
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Telephone | 510-887-6835
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Fax | 510-887-2872
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Authorized Official
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Title or Position | DENTIST
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Name | DR. JAIME VICTORES EVANGELISTA JR.
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Credential | D.M.D.
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Telephone | 510-887-6835
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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 | 37103
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License Number State | CA
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