Provider Demographics
NPI:1184744864
Name:EDUVALA, CLARENCIO A (DMD)
Entity type:Individual
Prefix:DR
First Name:CLARENCIO
Middle Name:A
Last Name:EDUVALA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31874 ALVARADO BLVD
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94587-3913
Mailing Address - Country:US
Mailing Address - Phone:510-487-4899
Mailing Address - Fax:510-487-6418
Practice Address - Street 1:31874 ALVARADO BLVD
Practice Address - Street 2:
Practice Address - City:UNION CITY
Practice Address - State:CA
Practice Address - Zip Code:94587-3913
Practice Address - Country:US
Practice Address - Phone:510-487-4899
Practice Address - Fax:510-487-6418
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA337531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice