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Evergreen Plaza Dental, Inc
Dental Clinic/Center in Mendocino, California
NPI 1750406963

Evergreen Plaza Dental, Inc is a Dental Clinic/Center based in Mendocino, CA and is specialized in Dental. Evergreen Plaza Dental, Inc practices in Mendocino, CA. The NPI Number for Evergreen Plaza Dental, Inc is 1750406963 and holds a License No. 27738 (California).

The current practice location address for Evergreen Plaza Dental, Inc is 45160 Main St, Mendocino, CA and can be reached out via phone at 707-964-4759.

Location: 45160 Main St, Mendocino, CA, 95460-2477
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1750406963
Provider Name
Evergreen Plaza Dental, Inc
Credential
Provider Entity Type
Organization
Address
45160 Main St, Mendocino, CA, 95460-2477
Phone Number
707-964-4759
Fax Number
Provider Enumeration Date
03/20/2007
Last Update Date
03/09/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
27738 01 CA DENTAL LICENSE
institution
Provider Business Practice Location Address Details
Address
45160 Main St
City
Mendocino
State
California
Zip
95460-2477
Phone Number
707-964-4759
Fax Number
person
Provider Business Mailing Address Details
Address
45160 Main St
City
Mendocino
State
California
Zip
95460-2477
Phone Number
707-964-4759
Fax Number
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Dental
Taxonomy
261QD0000X
License No.
27738 (California)
Definition
Definition to come...
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