EVERGREEN DENTURE CENTER NPI 1184051054

NPI Information

  • NPI: 1184051054
  • Provider Name: EVERGREEN DENTURE CENTER
  • Classification: Denturist - 122400000X
  • Entity Type: Organization
  • CLIA Number: 50D2319394
  • Address: 13720 NE 28TH ST
    VANCOUVER, WA
    ZIP 98682
  • Phone: (360) 256-4656

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NPI Details

EVERGREEN DENTURE CENTER is a denturist in Vancouver, WA. The provider is a denturist is a licensed professional that serves patients with removable dental prosthetic oral health needs. A licensed denturist is trained in removable dental prosthetics and the fabrication of such devices. EVERGREEN DENTURE CENTER NPI is 1184051054. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

13720 NE 28TH ST
VANCOUVER, WA
ZIP 98682-289
Phone: (360) 256-4656
Fax: (360) 256-2829

The provider's authorized official is Vadim Zalyashko .
The authorized official title is Denturist and has the following contact phone number (360) 256-4656.

The CLIA number assigned to this NPI record is 50D2319394 - other - afh with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/8/2013 and was last updated on 10/8/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1122400000XDenturistYes

What is NPI?

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This page was last updated on: 11/21/2025

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