Provider Demographics
NPI:1023839891
Name:EVERGROW DENTAL PLLC
Entity type:Organization
Organization Name:EVERGROW DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAYLA
Authorized Official - Middle Name:CLAIRE
Authorized Official - Last Name:KLINGENSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:607-654-9447
Mailing Address - Street 1:1573 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17601-5233
Mailing Address - Country:US
Mailing Address - Phone:607-654-9447
Mailing Address - Fax:
Practice Address - Street 1:1860 OREGON PIKE STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17601-6402
Practice Address - Country:US
Practice Address - Phone:607-654-9447
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-23
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental