| Evergreen Smiles | |
|
289 E Ellendale Ave Ste 201 Dallas OR 97338-1541 | |
| (770) 876-5404 | |
| Not Available |
| Full Name | Evergreen Smiles |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 289 E Ellendale Ave Ste 201, Dallas, Oregon |
| Authorized Official Name and Position | Tanner Weeks (OWNER/DENTIST) |
| Authorized Official Contact | 7708765404 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Smiles 7015 Riva Ridge Dr Se Turner OR 97392-9455 Ph: () - | Evergreen Smiles 289 E Ellendale Ave Ste 201 Dallas OR 97338-1541 Ph: (770) 876-5404 |
| NPI Number | 1205628104 |
|---|---|
| Provider Enumeration Date | 05/19/2025 |
| Last Update Date | 05/19/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205628104 | NPI | - | NPPES |
| 1881433670 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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