Evergreen Dentistry, LLC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

050969 Issued in NY

Legal business name

EVERGREEN DENTISTRY, LLC

Practice address

4748 203Rd St
Bayside, NY 11361-3039

Phone

(718) 578-1126

Fax

(718) 578-1126

NPI assigned

Jun 26, 2007

Last updated

Aug 22, 2020By 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

Dr. Andrew Kim, DDSNPI 1972709756

Title

President

Phone

(718) 578-1126

Specialties & licenses 1

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew D. Kim, DDS

  • Dentist
  • Glendale, NY
  • NPI 1972709756
  NPD (past) Authorized official

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

{
    "created_epoch": "1182816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1790981579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4748 203RD ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613039",
            "telephone_number": "718-578-1126",
            "fax_number": "718-578-1126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4748 203RD ST",
            "city": "BAYSIDE",
            "state": "NY",
            "postal_code": "113613039",
            "telephone_number": "718-578-1126",
            "fax_number": "718-578-1126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTISTRY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KIM",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "718-578-1126",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "NY",
            "license": "050969",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02685578",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Desiree Estevez
• Angela Estrella
• Eten Dental PLLC (Eten Dental)
• Seham Etouni
• Anastasia Evanoff, M.S.ED, CCC-SLP
• Eye & I Eyecare LLC
• Eyes on Bell Inc
• Majda Nadine Fadika
• Giulia Fagan
• Dimitrios Fantakos

• Dental Clinic/Center in Bayside, NY
• Providers in Bayside, NY by specialty
• Dental Clinic/Center in New York

• 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.