| Evergreen Dental Anesthesia Pllc | |
|
357 Mccaslin Blvd Ste 200 Louisville CO 80027-2932 | |
| (970) 699-8954 | |
| Not Available |
| Full Name | Evergreen Dental Anesthesia Pllc |
|---|---|
| Speciality | Dentist - Dentist Anesthesiologist |
| Location | 357 Mccaslin Blvd Ste 200, Louisville, Colorado |
| Authorized Official Name and Position | Nathan James Carillo (PRESIDENT/OWNER) |
| Authorized Official Contact | 5626738732 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evergreen Dental Anesthesia Pllc 357 Mccaslin Blvd Ste 200 Louisville CO 80027-2932 Ph: (970) 699-8954 | Evergreen Dental Anesthesia Pllc 357 Mccaslin Blvd Ste 200 Louisville CO 80027-2932 Ph: (970) 699-8954 |
| NPI Number | 1821684713 |
|---|---|
| Provider Enumeration Date | 12/15/2020 |
| Last Update Date | 12/15/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821684713 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0004X | Dentist - Dentist Anesthesiologist | (* (Not Available)) | Primary |
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