Provider Demographics
NPI:1437369329
Name:LAYSON, ROWENA V (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROWENA
Middle Name:V
Last Name:LAYSON
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 1:1255 MAGNOLIA AVE
Mailing Address - Street 2:SUITE # 105
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-5004
Mailing Address - Country:US
Mailing Address - Phone:951-736-7413
Mailing Address - Fax:951-736-7960
Practice Address - Street 1:1255 MAGNOLIA AVE
Practice Address - Street 2:SUITE # 105
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-5004
Practice Address - Country:US
Practice Address - Phone:951-736-7413
Practice Address - Fax:951-736-7960
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA493551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice