Provider Demographics
NPI:1710253455
Name:MARUKO, EVELYN Y (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:Y
Last Name:MARUKO
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6370 E SANTA ANA CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2365
Mailing Address - Country:US
Mailing Address - Phone:714-685-3890
Mailing Address - Fax:714-685-3895
Practice Address - Street 1:6370 E SANTA ANA CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2365
Practice Address - Country:US
Practice Address - Phone:714-685-3890
Practice Address - Fax:714-685-3895
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA398381223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics