Individual
DR. MAYLANI EVANGELISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3410 80TH ST, KENOSHA, WI 53142-4975
(262) 697-0825
(262) 697-0116
Mailing address
3410 80TH ST, KENOSHA, WI 53142-4975
(262) 697-0825
(262) 697-0116
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
5469
WI
Other
Enumeration date
02/06/2007
Last updated
07/08/2007
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