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Organization
EVERGREEN ORAL SURGERY
Active
Organization
EVERGREEN ORAL SURGERY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE MINKS (CREDENTIALING SPECIALIST)
(740) 243-6241
Entity
Organization
Contact information
Practice address
6050 TACOMA MALL BLVD STE 330, TACOMA, WA 98409-6811
(253) 473-0651
(253) 444-0761
Mailing address
13894 SUNLADEN CT, PICKERINGTON, OH 43147-8216
(740) 243-6241
(740) 919-5871
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
NULL
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
—
—
Other
Enumeration date
01/14/2021
Last updated
01/14/2021
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