Evergreen Dental, Llc

LBN: Evergreen Dental, Llc
Evergreen Dental, Llc is an health care organization with primary practice located at 125 W Evergreen Ave Ste 204 , Palmer AK 99645-6908. The organization recently has only one registered license in Dental Providers / Dentist, which is considered as the primary health care specialty. Evergreen Dental, Llc can be contacted via phone (907) 531-3477, or through Middleton, Rachael Fetuao via phone (907) 276-4537.

Contact Information

Primary practice address
125 W Evergreen Ave Ste 204 Palmer AK 99645-6908
Phone: (907) 531-3477
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Middleton, Rachael Fetuao
Phone: (907) 276-4537

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X

Profile Details

NPI number 1518574052
LBN Legal business name Evergreen Dental, Llc
DBA Doing business as
Authorized official Middleton, Rachael Fetuao
Entity Organization
Organization subpart 1 No
Enumeration date Sep 29th, 2020
Last updated Sep 29th, 2020 - about 5 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1518574052 NPPES
Alaska MEDICAID 1922430040
Alaska MEDICAID 1417158080

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