Provider Demographics
NPI:1750501607
Name:TAKANE, EVELYN SACHIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:SACHIE
Last Name:TAKANE
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:PO BOX 1288 1200 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:HOOPA
Mailing Address - State:CA
Mailing Address - Zip Code:95546
Mailing Address - Country:US
Mailing Address - Phone:714-742-0142
Mailing Address - Fax:
Practice Address - Street 1:1200 AIRPORT ROAD
Practice Address - Street 2:
Practice Address - City:HOOPA
Practice Address - State:CA
Practice Address - Zip Code:95546
Practice Address - Country:US
Practice Address - Phone:530-625-4261
Practice Address - Fax:530-625-4951
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35345122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist