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Organization
EVERGREEN DENTAL PLLC
Active
Organization
EVERGREEN DENTAL PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVA LAU DDS (CEO)
(612) 298-5816
Entity
Organization
Contact information
Practice address
7890 MITCHELL RD, EDEN PRAIRIE, MN 55344-2219
(952) 937-7677
Mailing address
14347 GOLF VIEW DR, EDEN PRAIRIE, MN 55346-3004
(952) 937-7677
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1003256876
NPI
MN
01
—
1144287962
NPI
MN
Enumeration date
11/07/2022
Last updated
11/07/2022
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