NPIMap

Organization Active NPI

Evergreen Dental Associates LLC

  • General Practice Dentistry
  • Augusta, ME
National Provider Identifier
1013121342
Registry record updated Mar 13, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
3692 Issued in ME
Legal business name
EVERGREEN DENTAL ASSOCIATES LLC
Practice address
281 Western Ave
Augusta, ME 04330-4933
Phone
(207) 622-0861
NPI assigned
May 9, 2007
Last updated
Mar 13, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Mikki M Studley
Title
Practice Administrator
Phone
(207) 622-0861

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 2482 ME
General Practice Dentistry 1223G0001X 3692 ME Primary

Addresses

Primary practice location

281 Western Ave
Augusta, ME 04330-4933

Mailing address

281 Western Ave
Augusta, ME 04330-4933
Phone (207) 622-0861

National Provider Directory

National Provider Directory

Locations

281 Western Ave
Augusta, ME 04330
Phone (207) 622-0861

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178668800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1331596800000",
    "number": "1013121342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "281 WESTERN AVE",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043304933",
            "telephone_number": "207-622-0861"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "281 WESTERN AVE",
            "city": "AUGUSTA",
            "state": "ME",
            "postal_code": "043304933",
            "telephone_number": "207-622-0861"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL ASSOCIATES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-09",
        "last_updated": "2012-03-13",
        "status": "A",
        "authorized_official_last_name": "STUDLEY",
        "authorized_official_first_name": "MIKKI",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "207-622-0861",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "2482",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "3692",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Augusta, ME

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.