NPIMap

Organization Active NPI

Evergreen Dental LLC

  • Dentist
  • Billerica, MA
National Provider Identifier
1831513126
Registry record updated Feb 7, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN1855668 Issued in MA
Legal business name
EVERGREEN DENTAL LLC
Practice address
790 Boston Rd Unit 205
Billerica, MA 01821-5938
Phone
(404) 932-8875
NPI assigned
Feb 7, 2014
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 7, 2014

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

Authorized official

Name
Jangwon Huh
Title
President
Phone
(404) 932-8875

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X DN1855668 MA Primary

Addresses

Primary practice location

790 Boston Rd Unit 205
Billerica, MA 01821-5938

Mailing address

790 Boston Rd Unit 205
Billerica, MA 01821-5938

National Provider Directory

National Provider Directory

Locations

790 Boston Rd
Unit 205
Billerica, MA 01821
Phone (404) 932-8875

NPI Registry JSON

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

{
    "created_epoch": "1391731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1391731200000",
    "number": "1831513126",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "790 BOSTON RD UNIT 205",
            "city": "BILLERICA",
            "state": "MA",
            "postal_code": "018215938"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "790 BOSTON RD UNIT 205",
            "city": "BILLERICA",
            "state": "MA",
            "postal_code": "018215938",
            "telephone_number": "404-932-8875"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVERGREEN DENTAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-02-07",
        "last_updated": "2014-02-07",
        "status": "A",
        "authorized_official_last_name": "HUH",
        "authorized_official_first_name": "JANGWON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "404-932-8875"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1855668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Billerica, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 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.