Organization
EVERGREEN DENTAL ANESTHESIA PLLC
Active
Other names
Evergreen Dental Anesthesia
Organization subpart
No
Provider details
NPI number
Authorized official
NATHAN JAMES CARILLO D.D.S. (PRESIDENT/OWNER)
(562) 673-8732
Entity
Organization
Contact information
Practice address
357 MCCASLIN BLVD STE 200, LOUISVILLE, CO 80027-2932
(970) 699-8954
Mailing address
357 MCCASLIN BLVD STE 200, LOUISVILLE, CO 80027-2932
(970) 699-8954
Taxonomy
Speciality
Code
Description
License number
State
1223D0004X
Dental Anesthesiology
Primary
—
—
Other
Enumeration date
12/15/2020
Last updated
12/15/2020
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