Provider Demographics
NPI:1497475784
Name:SUMARLI, EUGENIE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENIE
Middle Name:C
Last Name:SUMARLI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26630 BARTON RD APT 718
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92373-4325
Mailing Address - Country:US
Mailing Address - Phone:714-770-1860
Mailing Address - Fax:
Practice Address - Street 1:1620 E 1ST ST STE 200
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3174
Practice Address - Country:US
Practice Address - Phone:951-800-8095
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107833122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist