Organization
PACIFIC ORAL PATHOLOGY LABORATORY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LEWIS EVERSOLE DDS (PRESIDENT)
(415) 929-6572
Entity
Organization
Contact information
Practice address
155 5TH ST, SAN FRANCISCO, CA 94103-2919
(415) 929-6572
Mailing address
PO BOX 10076, VAN NUYS, CA 91410-0076
(805) 578-8300
(805) 578-8950
Taxonomy
Speciality
Code
Description
License number
State
292200000X
Dental Laboratory
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
LAB64366F
—
CA
Enumeration date
04/04/2006
Last updated
03/28/2017
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