Organization
EVERGRIN LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. PRIYA TRIVEDI (PARTNER/DIRECTOR)
(267) 981-2652
Entity
Organization
Contact information
Practice address
2416 S BROAD ST, PHILADELPHIA, PA 19145-4418
(267) 981-2652
Mailing address
320 N OXFORD VALLEY RD, FAIRLESS HILLS, PA 19030-2610
(215) 946-9400
(215) 946-9409
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS038095
PA
Other
Enumeration date
07/17/2014
Last updated
07/17/2014
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