Evergreen Dental Englewood LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

EVERGREEN DENTAL ENGLEWOOD LLC

Practice address

625 W National Rd Ste B
Englewood, OH 45322-1162

Phone

(937) 836-7911

NPI assigned

Feb 26, 2025

Last updated

Feb 26, 2025By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Sabrina Chiu

Title

Credentialing Coordinator

Phone

(740) 580-2000

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1740528000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1740528000000",
    "number": "1700683711",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 17419",
            "city": "SUGAR LAND",
            "state": "TX",
            "postal_code": "774967419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 W NATIONAL RD STE B",
            "city": "ENGLEWOOD",
            "state": "OH",
            "postal_code": "453221162",
            "telephone_number": "937-836-7911"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL ENGLEWOOD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-02-26",
        "last_updated": "2025-02-26",
        "certification_date": "2025-02-26",
        "status": "A",
        "authorized_official_last_name": "CHIU",
        "authorized_official_first_name": "SABRINA",
        "authorized_official_title_or_position": "CREDENTIALING COORDINATOR",
        "authorized_official_telephone_number": "740-580-2000"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Timothy Enscoe
• Caroline Erwin
• Jordan Thomas Eshbaugh, AT
• Karl Gerardo Espeleta, DDS
• Amanda Evans
• Extended Family Homecare
• Beverly J Fanz, D.D.S.
• FHS Englewood, Inc.
• First Choice Home Health Care
• Martika Fisher, PA

• Dentist in Englewood, OH
• Providers in Englewood, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 26, 2025; 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.