Evergreen Dental, Inc.

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

EVERGREEN DENTAL, INC.

Practice address

833 N Wilke Rd
Arlington Heights, IL 60005-1047

Phone

(847) 999-8004

NPI assigned

Oct 14, 2020

Organization subpart

No

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

Authorized official

Name

Dr. Timothy P Bashford, DDSNPI 1992857684

Title

Owner/Dentist

Phone

(847) 999-8004

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Timothy P Bashford, DDS

  • General Practice Dentistry
  • Arlington Heights, IL
  • NPI 1992857684
  NPD Authorized official

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

{
    "created_epoch": "1602633600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695168000000",
    "number": "1396343133",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8347",
            "city": "NORTHFIELD",
            "state": "IL",
            "postal_code": "600938347",
            "telephone_number": "847-999-8004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "833 N WILKE RD",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600051047",
            "telephone_number": "847-999-8004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-14",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-20",
        "status": "A",
        "authorized_official_last_name": "BASHFORD",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "OWNER/DENTIST",
        "authorized_official_telephone_number": "847-999-8004",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Arlington Heights, IL
• Providers in Arlington Heights, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 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.