Provider Demographics
NPI:1124822069
Name:RADISAY, EVA (DDS)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:RADISAY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4551 PARKRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-1250
Mailing Address - Country:US
Mailing Address - Phone:916-662-5093
Mailing Address - Fax:
Practice Address - Street 1:5665 FREEPORT BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3517
Practice Address - Country:US
Practice Address - Phone:916-427-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-01
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA446261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice