Provider Demographics
NPI:1376543835
Name:SHITABATA, EVANGELINE UY (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVANGELINE
Middle Name:UY
Last Name:SHITABATA
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Gender:F
Credentials:DDS
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Mailing Address - Street 1:23451 MADISON ST
Mailing Address - Street 2:#170
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-4763
Mailing Address - Country:US
Mailing Address - Phone:310-375-5437
Mailing Address - Fax:310-375-7608
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:#170
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4763
Practice Address - Country:US
Practice Address - Phone:310-375-5437
Practice Address - Fax:310-375-7608
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CA400371223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry