Organization · Type 2 NPI
Evergreen Plaza Dental, Inc
Dental Clinic/Center · Mendocino, CA
NPI number
1750406963
Active
Practice location
45160 Main St
Mendocino, CA 95460-2477
Mailing address
PO Box 2477
Mendocino, CA 95460-2477
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dental Clinic/Center Primary | 261QD0000X | 27738 (CA) |
Dental Clinic/Center: Definition to come...
About NPI 1750406963
Evergreen Plaza Dental, Inc's National Provider Identifier is 1750406963, issued on Mar 20, 2007. The primary taxonomy on file is Dental Clinic/Center (261QD0000X), and the practice location is in Mendocino, CA. The record was last updated on Sep 12, 2009.