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EVERGREEN DENTISTRY, LLC
NPI 1790981579
Clinic/Center - Dental in Bayside, NY

Active since June 26, 2007
4748 203RD ST, BAYSIDE, NY 11361(718) 578-1126(718) 578-1126 Get Directions Write a Review

NPPES record last updated: August 22, 2020. Verified against the NPPES registry weekly; last sync: August 30, 2026.

About Evergreen Dentistry, Llc NPPES

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

EVERGREEN DENTISTRY, LLC (NPI 1790981579) is a healthcare organization registered as a dental in Bayside, New York and active in the NPI registry since June 2007. The organization lists Andrew Kim, President, as its authorized official.

NPPES Registry Identity

NPI1790981579
Entity TypeOrganization
Primary Taxonomy261QD0000X
Legal Business NameEVERGREEN DENTISTRY, LLC
Location Address4748 203RD STBayside, NY 11361-3039
Mailing Address4748 203rd StBayside, NY 11361-3039 · (718) 578-1126 · Fax (718) 578-1126
Phone(718) 578-1126
Fax(718) 578-1126
Organization SubpartNo
Authorized OfficialAndrew KimPresident · (718) 578-1126
Enumeration DateJune 26, 2007
Last NPPES UpdateAugust 22, 2020
✔ NPI 1790981579 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · DentalAmbulatory Health Care Facilities
Taxonomy Code261QD0000X
License✔ Licensed in NY · 050969
4748 203RD ST, Bayside, NY 11361
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Other Identifiers 1

Medicaid02685578NY

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 Dentistry, LLC's NPI number?

The NPI number for Evergreen Dentistry, LLC is 1790981579. It was assigned to this organization in the NPPES registry on June 26, 2007.

Where is Evergreen Dentistry, LLC located?

Evergreen Dentistry, LLC is located at 4748 203rd St, Bayside, NY 11361. The listed phone number is (718) 578-1126.

What is Evergreen Dentistry, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Dental, with taxonomy code 261QD0000X.

When was this NPI record last updated?

The NPPES record for Evergreen Dentistry, LLC was last updated on August 22, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.