| Evergreen Dental, Llc | |
|
125 W Evergreen Ave Ste 204 Palmer AK 99645-6908 | |
| (907) 531-3477 | |
| Not Available |
| Full Name | Evergreen Dental, Llc |
|---|---|
| Speciality | Dentist |
| Location | 125 W Evergreen Ave Ste 204, Palmer, Alaska |
| Authorized Official Name and Position | Rachael Fetuao Middleton (CHIEF OPERATIONS OFFICER) |
| Authorized Official Contact | 9072764537 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Dental, Llc 125 W Evergreen Ave Ste 204 Palmer AK 99645-6908 Ph: (907) 531-3477 | Evergreen Dental, Llc 125 W Evergreen Ave Ste 204 Palmer AK 99645-6908 Ph: (907) 531-3477 |
| NPI Number | 1518574052 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 09/29/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518574052 | NPI | - | NPPES |
| 1922430040 | Medicaid | AK | |
| 1417158080 | Medicaid | AK |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
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