| NPI | 1871329292 |
|---|---|
| Doing Business As | EVERGREEN DENTAL |
| Entity Type | Organization |
| Authorized Contact | JACOB M HUSTAD Dentist 608-345-1410 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2024-09-11 |
| Last Update Date | 2024-09-11 |