Evergreen Dental LLC

Primary specialty

DentistTaxonomy code 122300000X

License

010332 Issued in CT

Legal business name

EVERGREEN DENTAL LLC

Practice address

109 Boston Post Rd
Orange, CT 06477-3235

Phone

(203) 298-0446

NPI assigned

Oct 13, 2011

Organization subpart

No

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

Authorized official

Name

Vikas Goel, DDS

Title

Owner

Phone

(203) 298-0446

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1730464470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5213 AVALON DR W",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773677",
            "telephone_number": "203-298-0466"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 BOSTON POST RD",
            "city": "ORANGE",
            "state": "CT",
            "postal_code": "064773235",
            "telephone_number": "203-298-0446"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-13",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "GOEL",
        "authorized_official_first_name": "VIKAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "203-298-0446",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "CT",
            "license": "010332",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Orange, CT
• Providers in Orange, CT by specialty
• Dentist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; 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.