Provider Demographics
NPI:1699540682
Name:EVERGREEN SMILES INC
Entity type:Organization
Organization Name:EVERGREEN SMILES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANDEEP
Authorized Official - Middle Name:KAUR
Authorized Official - Last Name:PANNU
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:203-703-2762
Mailing Address - Street 1:4379 LEGACY GREENS DR
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:OH
Mailing Address - Zip Code:45103-7109
Mailing Address - Country:US
Mailing Address - Phone:203-703-2762
Mailing Address - Fax:
Practice Address - Street 1:9100 W CHESTER TOWNE CTR STE 9270
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:OH
Practice Address - Zip Code:45069-3106
Practice Address - Country:US
Practice Address - Phone:203-703-2762
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty