Provider Demographics
NPI:1417658337
Name:EVALINA JOSEFSSON DENTAL GROUP
Entity Type:Organization
Organization Name:EVALINA JOSEFSSON DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EVALINA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEFSSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:818-788-8840
Mailing Address - Street 1:5400 BALBOA BLVD STE 308
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5221
Mailing Address - Country:US
Mailing Address - Phone:818-788-8840
Mailing Address - Fax:818-788-8841
Practice Address - Street 1:5400 BALBOA BLVD STE 308
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5221
Practice Address - Country:US
Practice Address - Phone:818-788-8840
Practice Address - Fax:818-788-8841
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty