Provider Demographics
NPI:1144616756
Name:CARLOS, EVELYN G (DMD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:G
Last Name:CARLOS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5824 WISH AVE
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1458
Mailing Address - Country:US
Mailing Address - Phone:818-551-9664
Mailing Address - Fax:
Practice Address - Street 1:5824 WISH AVE
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1458
Practice Address - Country:US
Practice Address - Phone:818-551-9664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA31583OtherCA DENTAL BOARD