# PACIFIC ORAL PATHOLOGY LABORATORY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1093777278
- **Authorized official:** LEWIS EVERSOLE DDS (PRESIDENT)
- **Authorized official phone:** (415) 929-6572

## Contact information

- **Practice address:** 155 5TH ST, SAN FRANCISCO, CA 94103-2919
- **Practice address phone:** (415) 929-6572
- **Mailing address:** PO BOX 10076, VAN NUYS, CA 91410-0076
- **Mailing address phone:** (805) 578-8300
- **Mailing address fax:** (805) 578-8950

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 292200000X | Dental Laboratory | — | NULL | Yes |

## Other

- **Enumeration date:** 04/04/2006
- **Last updated:** 03/28/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | LAB64366F | — | CA |