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General NPI Number Information
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NPI Number | 1396601688
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Entity Type | Organization
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Legal Business Name | EVERGREEN FAMILY DENTAL, MILL CREEK, INC
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Dates
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Enumeration Date | 12/30/2025
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Last Update Date | 12/30/2025
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Provider Practice Location Address
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Address Line | 15224 MAIN ST STE 301
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City | MILL CREEK
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State | WA
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Zip | 98012-7332
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Country | US
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Telephone | 425-338-4999
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Fax | 425-338-1055
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Provider Business Mailing Address
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Address Line | 15224 MAIN ST STE 301
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City | MILL CREEK
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State | WA
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Zip | 98012-7332
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Country | US
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Telephone | 425-338-4999
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Fax | 425-338-1055
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CAITLYN BATES
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Credential |
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Telephone | 425-338-4999
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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