Evergrin LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS038095 Issued in PA

Legal business name

EVERGRIN LLC

Practice address

2416 S Broad St
Philadelphia, PA 19145-4418

Phone

(267) 981-2652

NPI assigned

Jul 17, 2014

Organization subpart

No

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

Authorized official

Name

Ms. Priya Trivedi

Title

Partner/Director

Phone

(267) 981-2652

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1405555200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1405555200000",
    "number": "1720495195",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 N OXFORD VALLEY RD",
            "city": "FAIRLESS HILLS",
            "state": "PA",
            "postal_code": "190302610",
            "telephone_number": "215-946-9400",
            "fax_number": "215-946-9409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2416 S BROAD ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191454418",
            "telephone_number": "267-981-2652"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGRIN LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-17",
        "last_updated": "2014-07-17",
        "status": "A",
        "authorized_official_last_name": "TRIVEDI",
        "authorized_official_first_name": "PRIYA",
        "authorized_official_title_or_position": "PARTNER/DIRECTOR",
        "authorized_official_telephone_number": "267-981-2652",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS038095",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Philadelphia, PA
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2014; 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.