| Evergreen Plaza Dental, Inc | |
|
45160 Main St Mendocino CA 95460-2477 | |
| (707) 964-4759 | |
| Not Available |
| Full Name | Evergreen Plaza Dental, Inc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 45160 Main St, Mendocino, California |
| Authorized Official Name and Position | Patrick Carney (PRESIDENT) |
| Authorized Official Contact | 7079644759 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Plaza Dental, Inc Po Box 2477 Mendocino CA 95460-2477 Ph: (707) 964-4759 | Evergreen Plaza Dental, Inc 45160 Main St Mendocino CA 95460-2477 Ph: (707) 964-4759 |
| NPI Number | 1750406963 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 09/12/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750406963 | NPI | - | NPPES |
| 27738 | Other | CA | DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 27738 (California) | Primary |