Provider Demographics
NPI:1003021494
Name:EVANS, ROSEMARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROSEMARY
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46096 VALENA STREET
Mailing Address - Street 2:
Mailing Address - City:DOS PALOS
Mailing Address - State:CA
Mailing Address - Zip Code:93620
Mailing Address - Country:US
Mailing Address - Phone:408-391-9501
Mailing Address - Fax:209-392-1378
Practice Address - Street 1:2680 S WHITE ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148
Practice Address - Country:US
Practice Address - Phone:408-531-9881
Practice Address - Fax:408-531-9580
Is Sole Proprietor?:No
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADD033083122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
033083CAOtherDELTA DENTAL