Evergreen Dental Group, LLC
NPI #1457641136 in South Windsor, Connecticut
Provider Information
- NPI Number
- 1457641136
- Entity Type
- Organization
- Organization Name
- Evergreen Dental Group, LLC
- Primary Specialty
- Dentist - General Practice
- Enumeration Date
- Apr 14, 2011
- Last Updated
- Apr 14, 2011
Practice Location
- Address
- 34 EVERGREEN WAY
- City
- South Windsor
- State
- Connecticut
- ZIP Code
- 06074-6976
- Phone
- (917) 453-4055
Authorized Official
- Name
- DR. CHIA HUI JENNY KWON
- Title
- PART OWNER/ DENTIST
- Phone
- (917) 453-4055
Specialties & Taxonomy Codes
| Specialty |
|---|
| Dentist - General Practice — General Practice |
| Dentist - Pediatric Dentistry — Pediatric Dentistry |
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