# EVERGREEN DENTAL

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

## Provider details

- **NPI number:** 1700222197
- **Authorized official:** DR. CHAD G WADE DDS (DENTIST)
- **Authorized official phone:** (360) 921-2396

## Contact information

- **Practice address:** 2403 E EVERGREEN BLVD, VANCOUVER, WA 98661-4320
- **Practice address phone:** (360) 696-1671
- **Mailing address:** 2403 E EVERGREEN BLVD, VANCOUVER, WA 98661-4320
- **Mailing address phone:** (360) 696-1671

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DE60041682 | WA | Yes |

## Other

- **Enumeration date:** 05/13/2013
- **Last updated:** 05/13/2013