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General NPI Number Information
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NPI Number | 1306277892
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Entity Type | Organization
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Legal Business Name | EVERGREEN PROSTHODONTIC ASSOCIATES, LLC
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Dates
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Enumeration Date | 12/09/2013
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Last Update Date | 03/30/2023
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Provider Practice Location Address
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Address Line | 1300 POST RD SUITE 101
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City | FAIRFIELD
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State | CT
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Zip | 06824-6038
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Country | US
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Telephone | 203-259-7870
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Fax |
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Provider Business Mailing Address
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Address Line | 1300 POST RD SUITE 101
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City | FAIRFIELD
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State | CT
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Zip | 06824-6038
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Country | US
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Telephone | 203-259-7870
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MINSUNG YOON
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Credential | DDS
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Telephone | 203-259-7870
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 9601
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number | 9863
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 1223P0700X
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Taxonomy Name | Prosthodontics
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License Number |
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License Number State |
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