Evergreen Dentistry, LLC
Evergreen Dentistry, LLC is a healthcare organization registered as Dental Clinic/Center in Bayside, NY, holding Type 2 (organization) NPI 1790981579 since 2007. The authorized official on file is Andrew Kim, President.
✓ Active NPI ✓ Valid NPI checksum
| NPI | 1790981579 |
|---|---|
| Entity type | Organization (Type 2) |
| Legal business name | Evergreen Dentistry, LLC |
| Practice address | 4748 203RD ST, Bayside, NY, 11361 |
| Phone | 7185781126 |
| Fax | 7185781126 |
| Enumeration date | 2007-06-26 |
| Last updated in NPPES | 2020-08-22 |
Authorized official
| Name | Andrew Kim |
|---|---|
| Title | President |
| Phone | 7185781126 |
Taxonomy & classification
| Taxonomy code | Specialty | Primary | License | State |
|---|---|---|---|---|
| 261QD0000X | Dental Clinic/Center | Primary | 050969 | NY |
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 02685578 | Medicaid | NY | — |
Copy-ready billing details
Provider: Evergreen Dentistry, LLC NPI: 1790981579 Taxonomy: 261QD0000X (Dental Clinic/Center) Address: 4748 203RD ST, Bayside, NY, 11361
Verify this record
Cross-check NPI 1790981579 against the authoritative CMS record: view Evergreen Dentistry, LLC on the official NPPES registry .
What is an NPI number?
A National Provider Identifier (NPI) is a unique 10-digit number that CMS assigns to every U.S. healthcare provider and organization under HIPAA. Type 1 NPIs identify individual providers; Type 2 NPIs identify organizations. The NPI appears on insurance claims, prescriptions, and credentialing paperwork, and never changes — even if the provider moves or changes specialty. Read the full guide or validate an NPI number.
Frequently asked questions
Who is the authorized official for Evergreen Dentistry, LLC?
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Source: CMS NPPES (public data). Snapshot 2026-07-11. Provider record last updated 2020-08-22.