EVERGREEN PROSTHODONTIC ASSOCIATES, LLC (NPI# 1336570357) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1336570357 |
| Entity Type | Organization |
| Organization Name | EVERGREEN PROSTHODONTIC ASSOCIATES, LLC |
| Other Organization Name | SOUTHBURY SMILES |
| Practice Address |
385 Main St S Suite 210 Southbury CT 06488-4240 |
| Practice Telephone | 2032641620 |
| Mailing Telephone | 2032641620 |
| Enumeration Date | 2013-12-01 |
| Last Update Date | 2013-12-01 |
| Authorized Official Name | DR. MICHELLE NA (OWNER) |
| Authorized Official Telephone | 2032641620 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 1223P0700X |
Dentist Specialization: Prosthodontics |
9601 | CT | Dental Providers |
| N | 1223G0001X |
Dentist Specialization: General Practice |
10217 | CT | Dental Providers |
| Y | 1223P0700X |
Dentist Specialization: Prosthodontics |
9863 | CT | Dental Providers |
| Other Name | Type Code |
|---|---|
| Southbury Smiles | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306277892 | Evergreen Prosthodontic Associates, LLC | Dentist | 1300 Post Rd, Suite 101, Fairfield, CT 06824-6038 | 2013-12-09 |
| Street Address |
385 MAIN ST S SUITE 210 |
| City | SOUTHBURY |
| State | CT |
| Zip Code | 06488-4240 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1811961014 | Michael C Trager | Internal Medicine | 385 Main St S, Union Square, Southbury, CT 06488 | 2006-02-14 |
| 1821507229 | Ariana Marie Cusack | Behavioral Analyst | 385 Main St S, Southbury, CT 06488-4240 | 2017-09-28 |
| 1760620678 | Maysoun Richi | Specialist | 385 Main St S, Southbury, CT 06488-4240 | 2009-01-30 |
| 1497956510 | Southbury Smiles, LLC | Dentist | 385 Main St S, Suite 210, Southbury, CT 06488-4240 | 2007-05-29 |
| 1043300338 | Donna M. Leddy | Physical Therapist | 385 Main St S, Suite 212, Southbury, CT 06488-4240 | 2006-10-15 |
| 1275621625 | Jane Hunter | Internal Medicine | 385 Main St S, Suite 106 Union Square, Southbury, CT 06488-4240 | 2006-10-11 |
| 1629165048 | Comprehensive Healthcare LLC | Internal Medicine | 385 Main St S, Suite 106, Southbury, CT 06488-4240 | 2006-10-06 |
| 1245334432 | Maureen Keegan Boyd | Physical Therapist | 385 Main St S, Ste 212, Southbury, CT 06488-4156 | 2006-09-11 |
| 1801909114 | Phase One Physical Therapy PC | Occupational Therapist | 385 Main St S, Ste 212, Southbury, CT 06488-4156 | 2006-08-17 |
| 1992730212 | Scott Segal | Radiology | 385 Main St S, Union Square Bldg#2, Southbury, CT 06488-4240 | 2006-07-12 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538646229 | Katherine Whalen | Physical Therapist | 655 Main Sreet South, Southbury, CT 06488 | 2018-07-25 |
| 1346779618 | Prestige Companion & Homemakers, LLC | Homemaker | 32 Poverty Rd, Suite F, Southbury, CT 06488 | 2017-06-08 |
| 1407225873 | Mary Synnott | Occupational Therapist | 25 Depot Hill Rd, Southbuty, CT 06488 | 2015-09-16 |
| 1568854735 | Jean Piacenza | Social Worker | 505 Heritage Road, Suite 104, Southbury, CT 06488 | 2015-02-25 |
| 1295174993 | Saeeda Qadri | Internal Medicine | 22 Old Waterbury Rd Ste 108, Southbury, CT 06488 | 2013-06-17 |
| 1538502133 | Hearing Aid Services Inc | Audiologist-Hearing Aid Fitter | 1449 Old Waterbury Rd Ste 303, Southbury, CT 06488 | 2013-04-12 |
| 1992064380 | Maria Hornak-houle | Social Worker | 88 Main St. S, Southbury, CT 06488 | 2012-05-07 |
| 1255641072 | Rebecha Kay Sullivan | Social Worker | 35 Timberland Way, Southbury, CT 06488 | 2010-10-14 |
| 1619115094 | Jennie L Kempf | Counselor | 33 Bullet Hill Rd Ste 204, Southbury, CT 06488 | 2009-01-23 |
| 1891949434 | Kelly Patrice Hochstetler | Occupational Therapist | 22 Old Waterbury Rd., Suite 101, Phys. Med. Ctr. of Southbury, Southbury, CT 06488 | 2008-11-10 |
| Find all providers in zip 06488 | ||||
| Taxonomy Code | 1223P0700X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Prosthodontics |
| That branch of dentistry pertaining to the restoration and maintenance of oral functions, comfort, appearance and health of the patient by the restoration of natural teeth and/or the replacement of missing teeth and contiguous oral and maxillofacial tissues with artificial substitutes. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356507933 | Michelle Na | Dentist | 2 Pomperaug Office Park, Suite 304, Southbury, CT 06488-2288 | 2008-08-01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063802221 | Benjanin M Frank | Dentist | 105 A Newton Road, Suite 4, Danbury, CT 06810-1603 | 2015-01-27 |
| 1801133293 | Ajay Kumar Dhingra | Dentist | 263 Farmington Ave Rm L6053, Farmington, CT 06030-1615 | 2013-01-06 |
| 1093085144 | Joel M Leon | Dentist | 138 Milbank Ave, Greenwich, CT 06830-6626 | 2012-01-06 |
| 1477751758 | Guillermo Zapata | Dentist | 25 Glenbrook Rd, Apt. 534, Stamford, CT 06902-2871 | 2007-07-06 |
| 1366651663 | Gary Edward Horblitt | Dentist | 2226 Black Rock Tpke, Fairfield, CT 06825 | 2007-05-22 |
| 1831304930 | Andrew Joseph Ponichtera | Dentist | 373 Hopmeadow St, Weatogue, CT 06089-9717 | 2007-05-11 |
| 1326268020 | Ervin Braun | Dentist | 24 Old Kings Hwy S, Darien, CT 06820-4537 | 2007-04-26 |
| 1447479233 | Dimitri Perdikis | Dentist | 820 Farmington Ave, West Hartford, CT 06119-1506 | 2007-04-24 |
| 1699822155 | Diane Elizabeth Gawronski | Dentist | 14 Westbrook Rd, Centerbrook, CT 06409 | 2007-01-05 |
| 1346305802 | Thomas D. Taylor | Dentist | Uconn Health Ctr, 263 Farmington Avenue, Mc-3915, Farmington, CT 06030-3915 | 2006-12-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.