Organization
EVERGREEN DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREW KIM DDS (PRESIDENT)
(718) 578-1126
Entity
Organization
Contact information
Practice address
4748 203RD ST, BAYSIDE, NY 11361-3039
(718) 578-1126
(718) 578-1126
Mailing address
4748 203RD ST, BAYSIDE, NY 11361-3039
(718) 578-1126
(718) 578-1126
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
050969
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02685578
—
NY
Enumeration date
06/26/2007
Last updated
08/22/2020
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