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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.

physician-icon Basic Information

Practice Location 45160 Main St, Mendocino, CA 95460-2477, US
Practice Location Phone707-964-4759
Practice Location Fax
Legal Business NameEVERGREEN PLAZA DENTAL, INC
NPI ?1750406963
Entity TypeOrganization
Enumeration Date ? Mar 20, 2007
Last Update Date ? Sep 12, 2009
Note:
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).

specialty-icon Specialties & Licenses of Evergreen Plaza Dental, Inc

SpecialtySpecializationLicenseLicense State
Clinic/CenterDental 27738California

legacy-id-icon Legacy Provider IDs of Evergreen Plaza Dental, Inc

Provider IdIssuer StateIssuer TypeIssuer
27738CaliforniaOtherDENTAL LICENSE

official-icon 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/PositionPRESIDENT
Authorized Official Phone Number707-964-4759