# EVERGREEN FAMILY DENTISTRY

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1497879001
- **Authorized official:** DR. GLEN A MONSON DDS (OWNER)
- **Authorized official phone:** (360) 805-0211

## Contact information

- **Practice address:** 17798 147TH ST SE, MONROE, WA 98272
- **Practice address phone:** (360) 805-0211
- **Practice address fax:** (360) 863-9222
- **Mailing address:** 17798 147TH ST SE, MONROE, WA 98272
- **Mailing address phone:** (360) 805-0211
- **Mailing address fax:** (360) 863-9222

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 7077 | WA | Yes |

## Other

- **Enumeration date:** 03/19/2007
- **Last updated:** 08/22/2020