Evergreen Plaza Dental, Inc

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

27738 Issued in CA

Legal business name

EVERGREEN PLAZA DENTAL, INC

Practice address

45160 Main St
Mendocino, CA 95460-2477

Phone

(707) 964-4759

NPI assigned

Mar 20, 2007

Last updated

Sep 12, 2009By 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

Patrick Carney, DDS

Title

President

Phone

(707) 964-4759

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1174348800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252713600000",
    "number": "1750406963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2477",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "954602477",
            "telephone_number": "707-964-4759"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45160 MAIN ST",
            "city": "MENDOCINO",
            "state": "CA",
            "postal_code": "954602477",
            "telephone_number": "707-964-4759"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN PLAZA DENTAL, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-20",
        "last_updated": "2009-09-12",
        "status": "A",
        "authorized_official_last_name": "CARNEY",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "707-964-4759",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "CA",
            "license": "27738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "27738",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arthur Robert Ciancutti, MD
• Amy Davis, R.D.M.S. 81478
• Bess Naima Donley, L.AC
• Dr Dearmond
• Frederick J. Dumas III, M.D.
• Joan Ruth Faber, MFT
• Gabriel Hernandez
• Sharon Ann Hunter, NP
• Jeffrey a Berenson MD a Professional Corporation
• Martha C Jimenez, LCSW

• Dental Clinic/Center in Mendocino, CA
• Providers in Mendocino, CA by specialty
• Dental Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2009; 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.