Evergreen Family Dentistry

Primary specialty

DentistTaxonomy code 122300000X

License

7077 Issued in WA

Legal business name

EVERGREEN FAMILY DENTISTRY

Practice address

17798 147TH St SE
Monroe, WA 98272

Phone

(360) 805-0211

Fax

(360) 863-9222

NPI assigned

Mar 19, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Glen A Monson, DDS

Title

Owner

Phone

(360) 805-0211

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1174262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1497879001",
    "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": "98272",
            "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": "98272",
            "telephone_number": "360-805-0211",
            "fax_number": "360-863-9222"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN FAMILY DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MONSON",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-805-0211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "WA",
            "license": "7077",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylee Redelle Evans, LMT
• Roger Evans
• Taylor Evans
• Dawn Michelle Evarts, LAC, EAMP
• Evergreen Family Dentistry
• Evergreen Family Dentistry, Inc.
• Roxanne Fairfax, LMT
• Carson Farmer
• Sarah Elizabth Farretta, CPC
• Walter Fasch, PHARMD

• Dentist in Monroe, WA
• Providers in Monroe, WA by specialty
• Dentist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.