NPIMap

Organization Active NPI

Evergreen Family Dentistry, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Monroe, WA
National Provider Identifier
1316213374
Registry record updated Mar 23, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
License
7077 Issued in WA
Legal business name
EVERGREEN FAMILY DENTISTRY, INC.
Practice address
17798 147TH St SE
Monroe, WA 98272-1030
Phone
(360) 805-0211
Fax
(360) 863-9222
NPI assigned
Mar 23, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 23, 2012

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

Authorized official

Name
Glen Monson, D.D.S
Title
Owner
Phone
(360) 805-0211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X 7077 WA Primary

Addresses

Primary practice location

17798 147TH St SE
Monroe, WA 98272-1030

Mailing address

17798 147TH St SE
Monroe, WA 98272-1030
Phone (360) 805-0211

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1332460800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332460800000",
    "number": "1316213374",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17798 147TH ST SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721030",
            "telephone_number": "360-805-0211",
            "fax_number": "360-863-9222"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17798 147TH ST SE",
            "city": "MONROE",
            "state": "WA",
            "postal_code": "982721030",
            "telephone_number": "360-805-0211",
            "fax_number": "360-863-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN FAMILY DENTISTRY, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-03-23",
        "last_updated": "2012-03-23",
        "status": "A",
        "authorized_official_last_name": "MONSON",
        "authorized_official_first_name": "GLEN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-805-0211",
        "authorized_official_credential": "D.D.S"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "WA",
            "license": "7077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Monroe, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 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.