Evergreen Plaza Dental, Inc
Evergreen Plaza Dental, Inc is a health care provider in Mendocino, CA. In this page you will find its mailing address, practice location, phone number, specialty etc.
|Practice Location|| 45160 Main St, Mendocino, CA 95460-2477, US |
|Practice Location Phone||707-964-4759|
|Practice Location Fax|
|Legal Business Name||EVERGREEN PLAZA DENTAL, INC|
|Enumeration Date ? ||Mar 20, 2007|
|Last Update Date ? ||Sep 12, 2009|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
Specialties & Licenses of Evergreen Plaza Dental, Inc
|Specialty||Provider Type||Specialization||License||License State|
|Clinic/Center||Ambulatory Health Care Facilities||Dental ||27738||California|
Legacy Provider IDs of Evergreen Plaza Dental, Inc
|Provider Id||Issuer State||Issuer Type||Issuer|
Authorized Official of Evergreen Plaza Dental, Inc
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Evergreen Plaza Dental, Inc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
|Authorized Official || Patrick Carney (DDS)|
|Authorized Official Title/Position||PRESIDENT|
|Authorized Official Phone Number||707-964-4759|