# EVERGREEN DENTAL P A

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

## Provider details

- **NPI number:** 1871876680
- **Authorized official:** DR. HEEJE LEE D.D.S. (OWNER)
- **Authorized official phone:** (972) 315-0811

## Contact information

- **Practice address:** 225 E STATE HIGHWAY 121 STE 117, COPPELL, TX 75019-2008
- **Practice address phone:** (972) 315-0811
- **Practice address fax:** (972) 315-0891
- **Mailing address:** 225 E STATE HIGHWAY 121 STE 117, COPPELL, TX 75019-2008
- **Mailing address phone:** (972) 315-0811
- **Mailing address fax:** (972) 315-0891

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 25602 | TX | Yes |

## Other

- **Enumeration date:** 09/28/2011
- **Last updated:** 09/28/2011