Organization
SAN DIEGO DENTAL SLEEP THERAPY, LLC
Active
Parent organization
RICHARD B. EVANS, D.D.S., INC.
Organization subpart
Yes
Provider details
NPI number
Legal business name
RICHARD B. EVANS, D.D.S., INC.
Authorized official
DR. RICHARD B EVANS D.D.S. (PRESIDENT)
(619) 460-0714
Entity
Organization
Contact information
Practice address
8530 LA MESA BLVD, SUITE 204, LA MESA, CA 91942-0966
(619) 460-0714
(619) 460-0707
Mailing address
8530 LA MESA BLVD, SUITE 204, LA MESA, CA 91942-0966
(619) 460-0714
(619) 460-0707
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
31914
CA
332BC3200X
Customized Equipment (DME)
31914
CA
335E00000X
Prosthetic/Orthotic Supplier
31914
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
31914
DENTIST - STATE LICENSE
CA
Enumeration date
06/14/2012
Last updated
06/14/2012
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