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EVERGREEN DENTAL GROUP, LLC
NPI 1457641136
Dentist - General Practice in South Windsor, CT

Active since April 14, 2011
34 EVERGREEN WAY, SOUTH WINDSOR, CT 06074(917) 453-4055 Get Directions Write a Review

NPPES record last updated: April 14, 2011. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Evergreen Dental Group, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVERGREEN DENTAL GROUP, LLC (NPI 1457641136) is a healthcare organization registered as a general practice in South Windsor, Connecticut and active in the NPI registry since April 2011. The organization lists Chia Hui Jenny Kwon, Part Owner/ Dentist, as its authorized official.

NPPES Registry Identity

NPI1457641136
Entity TypeOrganization
Primary Taxonomy1223G0001X
Legal Business NameEVERGREEN DENTAL GROUP, LLC
Location Address34 EVERGREEN WAYSouth Windsor, CT 06074-6976
Mailing Address34 Evergreen WaySouth Windsor, CT 06074-6976 · (917) 453-4055
Phone(917) 453-4055
Organization SubpartNo
Authorized OfficialChia Hui Jenny KwonPart Owner/ Dentist · (917) 453-4055
Enumeration DateApril 14, 2011
✔ NPI 1457641136 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDentist · General PracticeDental Providers
Taxonomy Code1223G0001X
Licenses✔ Licensed in CT · 010110✔ Licensed in CT · 010241
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Also ListedDentist · Pediatric DentistryTaxonomy 1223P0221X · License 010004 (CT)
34 EVERGREEN WAY, South Windsor, CT 06074
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Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evergreen Dental Group, LLC's NPI number?

The NPI number for Evergreen Dental Group, LLC is 1457641136. It was assigned to this organization in the NPPES registry on April 14, 2011.

Where is Evergreen Dental Group, LLC located?

Evergreen Dental Group, LLC is located at 34 Evergreen Way, South Windsor, CT 06074. The listed phone number is (917) 453-4055.

What is Evergreen Dental Group, LLC's specialty?

The primary specialty registered for this NPI is Dentist, specializing in General Practice, with taxonomy code 1223G0001X.

When was this NPI record last updated?

The NPPES record for Evergreen Dental Group, LLC was last updated on April 14, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.