Evergreen Dental Anesthesia PLLC

Primary specialty

Dental AnesthesiologyTaxonomy code 1223D0004X

Legal business name

EVERGREEN DENTAL ANESTHESIA PLLC

Practice address

357 McCaslin Blvd Ste 200
Louisville, CO 80027-2932

Phone

(970) 699-8954

NPI assigned

Dec 15, 2020

Organization subpart

No

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

Authorized official

Name

Nathan James Carillo, D.D.S.NPI 1841647294

Title

President/Owner

Phone

(562) 673-8732

Specialties & licenses 1

Addresses

Other names 1

• Evergreen Dental Anesthesia Doing business as

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Nathan James Carillo, DDS

  • Dental Anesthesiology
  • Louisville, CO
  • NPI 1841647294
  NPD Authorized official

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

{
    "created_epoch": "1607990400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607990400000",
    "number": "1821684713",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "357 MCCASLIN BLVD STE 200",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272932",
            "telephone_number": "970-699-8954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "357 MCCASLIN BLVD STE 200",
            "city": "LOUISVILLE",
            "state": "CO",
            "postal_code": "800272932",
            "telephone_number": "970-699-8954"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL ANESTHESIA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-12-15",
        "last_updated": "2020-12-15",
        "certification_date": "2020-12-15",
        "status": "A",
        "authorized_official_last_name": "CARILLO",
        "authorized_official_first_name": "NATHAN",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "562-673-8732",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "1223D0004X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Dental Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Evergreen Dental Anesthesia",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Embody the Temple Healing Arts, LLC
• Jack Francis Emmons, D.D.S.
• Hope Engel, PT
• Samuel Eskenazi, RPH
• Alireza Etemadi, M.D.
• Excellence in Dentistry
• Exceptional Voice, Inc.
• Kylie Eynon, PT, DPT
• Christopher Fahs, PT
• Melanie Michelle Fargo, M.A. CCC-SLP

• Dental Anesthesiology in Louisville, CO
• Providers in Louisville, CO by specialty
• Dental Anesthesiology in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.