Evergreen Dental Group, LLC
Dentist, General Practice in South Windsor, Connecticut
1457641136- Practice location
- 34 Evergreen Way, South Windsor, CT 06074-6976
- Phone
- 917-453-4055
- Fax
- —
- Last updated
- April 14, 2011
Evergreen Dental Group, LLC is a healthcare organization based in South Windsor, CT. Evergreen Dental Group, LLC practices in South Windsor, CT. The NPI Number for Evergreen Dental Group, LLC is 1457641136 and holds a License No. 010241 (CT). The current practice location address for Evergreen Dental Group, LLC is 34 Evergreen Way, South Windsor, CT 06074-6976 and can be reached out via phone at 917-453-4055.
Provider Profile Details
- NPI Number
- 1457641136
- Provider Name
- Evergreen Dental Group, LLC
- Provider Entity Type
- Organization
- Address
- 34 Evergreen Way, South Windsor, CT 06074-6976
- Phone Number
- 917-453-4055
- Primary Taxonomy
- Dentist, General Practice · 1223G0001X
- Organization Subpart
- No
- Authorized Official
- Dr. Chia Hui Jenny Kwon · Part Owner/ Dentist · 917-453-4055
- Provider Enumeration Date
- April 14, 2011
- Last Update Date
- April 14, 2011
- NPI Status
- Active
Provider Business Practice Location Address Details
- Address
- 34 Evergreen Way
South Windsor, CT 06074-6976 - City
- South Windsor
- State
- Connecticut
- Zip
- 06074-6976
- Phone Number
- 917-453-4055
Provider Business Mailing Address Details
- Address
- 34 Evergreen Way
South Windsor, CT 06074-6976 - City
- South Windsor
- State
- CT
- Zip
- 06074-6976
- Phone Number
- 917-453-4055
License Information
- License Number (1)
- 010241
- License State (1)
- CT
- Taxonomy (1)
- Dentist, General Practice · 1223G0001X
- License Number (2)
- 010004
- License State (2)
- CT
- Taxonomy (2)
- Dentist, Pediatric Dentistry · 1223P0221X
- License Number (3)
- 010110
- License State (3)
- CT
- Taxonomy (3)
- Dentist, General Practice · 1223G0001X · Primary
Legacy Identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| No legacy identifiers (Medicaid, Medicare or plan IDs) are on file for this provider. | |||
Other Dentist, General Practice providers near South Windsor, CT
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- Dr. Daniel M Segal, DMDDentist, General Practice · NPI 1083787527
- Dr. Douglas C ClouserDentist, General Practice · NPI 1740492206
- Dr. Helen W Tang, DMDDentist, General Practice · NPI 1811270671
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Frequently Asked Questions
What is the NPI number of Evergreen Dental Group, LLC?
The NPI number of Evergreen Dental Group, LLC is 1457641136. It was assigned on April 14, 2011 and is currently active in the NPPES registry.
What is the specialty of Evergreen Dental Group, LLC?
Evergreen Dental Group, LLC is registered under the primary taxonomy Dentist, General Practice (code 1223G0001X), licensed in CT under license number 010241.
Where does Evergreen Dental Group, LLC practice?
The practice location is 34 Evergreen Way, South Windsor, CT 06074-6976. The office can be reached at 917-453-4055 (phone).
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS). It is used in HIPAA standard transactions.
How do I verify this NPI record?
This record is sourced from the public NPPES NPI Registry maintained by CMS. You can confirm it by searching NPI 1457641136 directly on the NPPES registry website.