Individual
MRS. EVEETTE MICHELLE TAVAKKOLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
647 CAMINO DE LOS MARES STE 209, SAN CLEMENTE, CA 92673-2807
(949) 493-9311
Mailing address
23701 ARJAY WAY, LAGUNA NIGUEL, CA 92677-4642
(949) 425-1120
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
21667
CA
Other
Enumeration date
06/26/2007
Last updated
07/08/2007
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