Provider Demographics
NPI:1649058728
Name:EVERGREEN SMILES DENTAL
Entity type:Organization
Organization Name:EVERGREEN SMILES DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROHI
Authorized Official - Middle Name:
Authorized Official - Last Name:ATASSI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:312-622-4406
Mailing Address - Street 1:9541 S PULASKI RD
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60805-1911
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9541 S PULASKI RD
Practice Address - Street 2:
Practice Address - City:EVERGREEN PARK
Practice Address - State:IL
Practice Address - Zip Code:60805-1911
Practice Address - Country:US
Practice Address - Phone:708-424-2220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental