Organization
EVERGREEN DENTAL LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VIKAS GOEL DDS (OWNER)
(203) 298-0446
Entity
Organization
Contact information
Practice address
109 BOSTON POST RD, ORANGE, CT 06477-3235
(203) 298-0446
Mailing address
5213 AVALON DR W, ORANGE, CT 06477-3677
(203) 298-0466
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
010332
CT
Other
Enumeration date
10/13/2011
Last updated
10/19/2011
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