EVERGREEN DENTAL, LLC (NPI# 1518574052) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518574052 |
| Entity Type | Organization |
| Organization Name | EVERGREEN DENTAL, LLC |
| Practice Address |
125 W Evergreen Ave Ste 204 Palmer AK 99645-6908 |
| Practice Telephone | 9075313477 |
| Mailing Telephone | 9075313477 |
| Enumeration Date | 2020-09-29 |
| Last Update Date | 2020-09-29 |
| Authorized Official Name | MRS. RACHAEL FETUAO MIDDLETON (CHIEF OPERATIONS OFFICER) |
| Authorized Official Telephone | 9072764537 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AK | 1922430040 | 05 | |
| AK | 1417158080 | 05 |
| Street Address |
125 W EVERGREEN AVE STE 204 |
| City | PALMER |
| State | AK |
| Zip Code | 99645-6908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295357135 | Kasey M Flintoft | Occupational Therapist | 7200 E. Jim Cottrell Cir, Palmer, AK 99645 | 2020-05-14 |
| 1629601471 | Courtney Randol | Licensed Practical Nurse | 14405 E Pace Dr., Palmer, AK 99645 | 2020-02-20 |
| 1689213092 | Valerie Anne Delaune | Acupuncturist | 9693 N. Little Otter Dr., Palmer, AK 99645 | 2020-01-02 |
| 1003464512 | Alaskan Sunrise Behavioral Health, L.L.C. | Clinic/Center | 14460 E. Pace Dr., Palmer, AK 99645 | 2019-08-28 |
| 1548814718 | Maple Springs of Palmer Snf Holdings, LLC | Skilled Nursing Facility | 12130 E Maple Springs Way, Palmer, AK 99645 | 2019-07-26 |
| 1952868655 | Carla Beth Kelly | Physical Therapist | 7200 Jim Cottrell Circle, Palmer, AK 99645 | 2019-02-28 |
| 1366938375 | Wendy S Page | Behavior Technician | 7200 E Jim Cottrell, Wasilla, AK 99645 | 2018-07-03 |
| 1154845170 | Sarah Elizabeth Gilliland | Occupational Therapist | 7200 E Jim Cottrell Circle, Palmer, AK 99645 | 2017-08-01 |
| 1558885137 | Garland Brooks | Massage Therapist | 1934 Prospect Dr, Palmer, AK 99645 | 2017-07-26 |
| 1386165009 | Sommer Dawn Nielsen | Massage Therapist | 3566 N Mars Ave., Palmer, AK 99645 | 2017-07-03 |
| Find all providers in zip 99645 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922463850 | Dr K's Pediatric Dentistry | Dentist | 125 W Evergreen Ave, #204, Palmer, AK 99645-6950 | 2015-12-18 |
| 1629284161 | Carol Michelle Neumann | Dentist | 1055 Park Street, Palmer, MA 01069-0677 | 2007-05-14 |
| 1740319789 | Mary Coyne | Dentist | 11951 E Palmer Wasilla Hwy, Palmer, AK 99645 | 2007-03-05 |
| 1679582019 | Richard Michael Gondek | Dentist | 1436 Main St, Palmer, MA 01069 | 2006-08-05 |
| 1881099117 | Lynsey Lindstrom Dds PC | Dentist | 561 S Denali St, Suite B, Palmer, AK 99645-6464 | 2014-10-29 |
| 1447466982 | Jonathan Edward Neumann | Dentist | 1055 Park Street, Palmer, MA 01069-0677 | 2007-05-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760081558 | Arne Anton Krogh | Dentist | 2665 E Tudor Rd Ste 300, Anchorage, AK 99507-1144 | 2020-10-22 |
| 1639716574 | Todd Haskin Dmd LLC | Dentist | 360 Old Chena Pump Rd Ste A, Fairbanks, AK 99709-2936 | 2019-12-10 |
| 1821649864 | Chase A Lundin | Dentist | 4001 Lake Otis Pkwy Ste 200, Anchorage, AK 99508-5200 | 2019-09-20 |
| 1992358261 | Shaun Mcnees | Dentist | 2805 Dawson St Ste 101, Anchorage, AK 99503-3800 | 2019-07-16 |
| 1194281725 | South Gate Cosmetic & Implant Dentistry LLC | Dentist | 12570 Old Seward Hwy Ste 201, Anchorage, AK 99515-3532 | 2019-02-19 |
| 1124593769 | Luff Orthodontics Partnership LLC | Dentist | 3708 Rhone Circle, Anchorage, AK 99508 | 2018-10-10 |
| 1457835167 | Motuuf, LLC. | Dentist | 3401 Denali St Ste 201, Anchorage, AK 99503-4001 | 2018-09-18 |
| 1609356310 | Iris Ohsie | Dentist | 1921 W Dimond Blvd Ste 101, Anchorage, AK 99515-1465 | 2018-08-21 |
| 1477041721 | Sameer Kapil, Dmd, LLC | Dentist | 951 E Bogard Rd Ste 203, Wasilla, AK 99654-7176 | 2018-04-23 |
| 1649797796 | Seong Guy Hyung | Dentist | 726 E 9th Avenue, Anchorage, AK 99501 | 2017-08-29 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.