Individual
EVANTHIA LALLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
630 W 168TH ST, CUCDM - PERIODONTICS, NEW YORK, NY 10032-3725
(212) 305-4511
Mailing address
630 W 168TH ST, CUCDM - PERIODONTICS, NEW YORK, NY 10032-3725
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
051651
NY
Other
Enumeration date
03/03/2008
Last updated
03/03/2008
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