Provider Demographics
NPI:1821284969
Name:ZEVALLOS, MIGUEL ARTURO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:ARTURO
Last Name:ZEVALLOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 KING CT
Mailing Address - Street 2:# 51
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-5506
Mailing Address - Country:US
Mailing Address - Phone:805-439-0260
Mailing Address - Fax:
Practice Address - Street 1:4251 S HIGUERA ST
Practice Address - Street 2:SUITE 502
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7700
Practice Address - Country:US
Practice Address - Phone:805-540-5251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2010-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist