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General NPI Number Information
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NPI Number | 1962608349
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Entity Type | Individual
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Provider Name | EVAN ELIZABETH LEMLEY DDS
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Gender | Female
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | VA LOMA LINDA HEALTH CARE SYSTEM # 160 11201 BENTON ST
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City | LOMA LINDA
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State | CA
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Zip | 92357-0001
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Country | US
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Telephone | 909-583-6127
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Fax |
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Provider Business Mailing Address
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Address Line | 25590 PROSPECT AVE 46F
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City | LOMA LINDA
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State | CA
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Zip | 92354-3141
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Country | US
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Telephone | 909-769-2236
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 55411
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License Number State | CA
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