# EVERGREEN DENTAL PA

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

## Provider details

- **NPI number:** 1649703216
- **Authorized official:** RICHARD RUDEN DMD (OWNER)
- **Authorized official phone:** (609) 226-6489

## Contact information

- **Practice address:** 549 S EVERGREEN AVE, WOODBURY, NJ 08097-1004
- **Practice address phone:** (609) 226-6489
- **Mailing address:** 549 S EVERGREEN AVE, WOODBURY, NJ 08097-1004
- **Mailing address phone:** (609) 226-6489

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 22DI01430100 | NJ | Yes |

## Other

- **Enumeration date:** 04/10/2017
- **Last updated:** 04/10/2017