NPIMap

Organization Active NPI

Evergreen Denture Center

  • Denturist
  • Vancouver, WA
National Provider Identifier
1184051054
Registry record updated Oct 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
DenturistTaxonomy code 122400000X
Legal business name
EVERGREEN DENTURE CENTER
Practice address
13720 NE 28TH St
Vancouver, WA 98682-8289
Phone
(360) 256-4656
Fax
(360) 256-2829
NPI assigned
Oct 8, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 8, 2013

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

Authorized official

Name
Vadim Zalyashko, DENTURISTNPI 1942630645
Title
Denturist
Phone
(360) 256-4656

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DenturistGroup: 193400000X SINGLE SPECIALTY GROUP 122400000X Primary

Addresses

Primary practice location

13720 NE 28TH St
Vancouver, WA 98682-8289

Mailing address

13720 NE 28TH St
Vancouver, WA 98682-8289
Phone (360) 256-4656

National Provider Directory

National Provider Directory

Locations

13720 NE 28th St
Vancouver, WA 98682
Phone (360) 256-4656

Practitioners & affiliated clinicians

Practitioners 1

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": "1381190400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1381190400000",
    "number": "1184051054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13720 NE 28TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986828289",
            "telephone_number": "360-256-4656",
            "fax_number": "360-256-2829"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13720 NE 28TH ST",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986828289",
            "telephone_number": "360-256-4656",
            "fax_number": "360-256-2829"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTURE CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-08",
        "last_updated": "2013-10-08",
        "status": "A",
        "authorized_official_last_name": "ZALYASHKO",
        "authorized_official_first_name": "VADIM",
        "authorized_official_title_or_position": "DENTURIST",
        "authorized_official_telephone_number": "360-256-4656",
        "authorized_official_credential": "DENTURIST"
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Denturist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vancouver, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2013; 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.