Evergreen Plaza Dental, INC
NPI #1750406963 in Mendocino, California
Provider Information
- NPI Number
- 1750406963
- Entity Type
- Organization
- Organization Name
- Evergreen Plaza Dental, INC
- Primary Specialty
- Clinic/Center - Dental
- Enumeration Date
- Mar 20, 2007
- Last Updated
- Sep 12, 2009
Practice Location
- Address
- 45160 MAIN ST
- City
- Mendocino
- State
- California
- ZIP Code
- 95460-2477
- Phone
- (707) 964-4759
Authorized Official
- Name
- PATRICK CARNEY, DDS
- Title
- PRESIDENT
- Phone
- (707) 964-4759
Specialties & Taxonomy Codes
| Specialty |
|---|
| Clinic/Center - Dental — Dental |
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