| NPI | 1629328638 |
|---|---|
| Other Name | EVERGREEN DENTAL CENTER |
| Entity Type | Organization |
| Authorized Contact | STEVEN P MARINKOVICH Owner/Doctor 253-474-3223 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment (Licence: WA DE00004767) |
| Additional Taxonomies | 1223G0001X Dentist, General Practice |
| Enumeration Date | 2012-09-17 |
| Last Update Date | 2014-02-14 |