Evergreen Dental, LLC

NPI #1518574052 in Palmer, Alaska

Provider Information

NPI Number: 1518574052
Entity Type: Organization
Organization Name: Evergreen Dental, LLC
Primary Specialty: Dentist
Enumeration Date: Sep 29, 2020
Last Updated: Sep 29, 2020

Practice Location

Address: 125 W EVERGREEN AVE STE 204
City: Palmer
State: Alaska
ZIP Code: 99645-6908
Phone: (907) 531-3477

Authorized Official

Name: MRS. RACHAEL FETUAO MIDDLETON
Title: CHIEF OPERATIONS OFFICER
Phone: (907) 276-4537

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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