NPIMap

Organization Active NPI

Evergreen Prosthodontic Associates, LLC

Doing business as Evergreen Family Dental

  • Prosthodontics
  • Fairfield, CT
National Provider Identifier
1306277892
Registry record updated Mar 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
ProsthodonticsTaxonomy code 1223P0700X
Legal business name
EVERGREEN PROSTHODONTIC ASSOCIATES, LLC
Doing business as
Evergreen Family Dental
Practice address
1300 Post Rd
Suite 101
Fairfield, CT 06824-6038
Phone
(203) 259-7870
NPI assigned
Dec 9, 2013
Last updated
Mar 30, 2023By the provider in NPPES
Organization subpart
Yes
Parent organization
EVERGREEN PROSRTHODONTIC ASSOCIATES, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Mar 30, 2023

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

Authorized official

Name
Minsung Yoon, DDSNPI 1619997004
Title
Owner
Phone
(203) 259-7870

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthodontics 1223P0700X 9601 CT
Prosthodontics 1223P0700X 9863 CT
Prosthodontics 1223P0700X NU Primary

Addresses

Primary practice location

1300 Post Rd
Suite 101
Fairfield, CT 06824-6038

Mailing address

1300 Post Rd
Suite 101
Fairfield, CT 06824-6038
Phone (203) 259-7870

Other names 1

  • Evergreen Family Dental Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Evergreen Prosthodontic Associates LLC2 organizations share this tax ID, including this one
Part of
Evergreen Prosthodontic Associates LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 3

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": "1386547200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680134400000",
    "number": "1306277892",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 POST RD",
            "address_2": "SUITE 101",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246038",
            "telephone_number": "203-259-7870"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1300 POST RD",
            "address_2": "SUITE 101",
            "city": "FAIRFIELD",
            "state": "CT",
            "postal_code": "068246038",
            "telephone_number": "203-259-7870"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PROSTHODONTIC ASSOCIATES, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "EVERGREEN PROSRTHODONTIC ASSOCIATES, LLC",
        "enumeration_date": "2013-12-09",
        "last_updated": "2023-03-30",
        "certification_date": "2023-03-30",
        "status": "A",
        "authorized_official_last_name": "YOON",
        "authorized_official_first_name": "MINSUNG",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-259-7870",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CT",
            "license": "9601",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "CT",
            "license": "9863",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Family Dental",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Evergreen Family Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fairfield, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; 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.