Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Evergreen Dental Group, LLC

Organization General Practice Dentistry · NPI 1457641136

Evergreen Dental Group, LLC is a General Practice Dentistry in South Windsor, Connecticut. Licensed in Connecticut. Registered with an NPI since 2011.

Licensed in
CT
In the registry since
2011
Specialties on file
3
What do these letters mean?
LLC — Limited liability company
A form of business registration, not a clinical qualification.

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Practice location Address checks out

34 Evergreen Way
South Windsor, CT 06074-6976
Phone: (917) 453-4055
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Dentistry (primary) Taxonomy 1223G0001X · Licence 010110 (CT)
General Practice Dentistry Taxonomy 1223G0001X · Licence 010241 (CT)
Pediatric Dentistry Taxonomy 1223P0221X · Licence 010004 (CT)

Record details

NPI number1457641136
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Chia Hui Kwon — Part Owner/ Dentist · (917) 453-4055
NPI enumeratedApril 14, 2011
Last updated in NPPESApril 14, 2011
Mailing address34 Evergreen Way, South Windsor, CT 06074-6976

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