Evergreen Plaza Dental, Inc | |
45160 Main St Mendocino CA 95460-2477 | |
(707) 964-4759 | |
Not Available |
Full Name | Evergreen Plaza Dental, Inc |
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Speciality | Clinic/center - Dental |
Location | 45160 Main St, Mendocino, California |
Authorized Official Name and Position | Patrick Carney (PRESIDENT) |
Authorized Official Contact | 7079644759 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Evergreen Plaza Dental, Inc Po Box 2477 Mendocino CA 95460-2477 Ph: (707) 964-4759 | Evergreen Plaza Dental, Inc 45160 Main St Mendocino CA 95460-2477 Ph: (707) 964-4759 |
NPI Number | 1750406963 |
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Provider Enumeration Date | 03/20/2007 |
Last Update Date | 09/12/2009 |
Identifier | Type | State | Issuer |
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1750406963 | NPI | - | NPPES |
27738 | Other | CA | DENTAL LICENSE |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | 27738 (California) | Primary |