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Organization

EVERGREEN DENTAL ASSOCIATES LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MRS. MIKKI M STUDLEY (PRACTICE ADMINISTRATOR)
(207) 622-0861
Entity
Organization

Contact information

Practice address
281 WESTERN AVE, AUGUSTA, ME 04330-4933
(207) 622-0861
Mailing address
281 WESTERN AVE, AUGUSTA, ME 04330-4933
(207) 622-0861

Taxonomy

Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
2482
ME
1223G0001X
General Practice Dentistry
Primary
3692
ME

Other

Enumeration date
05/09/2007
Last updated
03/13/2012
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