Provider Demographics
NPI:1003038142
Name:EYRE, CLARICE LAW (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:CLARICE
Middle Name:LAW
Last Name:EYRE
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:DR
Other - First Name:CLARICE
Other - Middle Name:SI-MIN
Other - Last Name:LAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MS
Mailing Address - Street 1:1248 S SYCAMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-1533
Mailing Address - Country:US
Mailing Address - Phone:323-931-7264
Mailing Address - Fax:
Practice Address - Street 1:100 UCLA MEDICAL PLZ STE 350
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-794-5750
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA434561223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics