# EVERGREEN DENTAL CENTER

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** EVERGREEN DENTAL CENTER
- **Other names:** Fort Deposit Dental Center
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1518155373
- **Legal business name:** EVERGREEN DENTAL CENTER
- **Authorized official:** DR. ROBERT P LOUIS DDS MPH (EXECUTIVE DIRECTOR)
- **Authorized official phone:** (251) 578-3331

## Contact information

- **Practice address:** 119 OLD FORT ROAD, SUITE B, FORT DEPOSIT, AL 36032
- **Practice address phone:** (334) 227-4000
- **Practice address fax:** (334) 227-3770
- **Mailing address:** PO BOX 266, 100 EDWINA STREET, EVERGREEN, AL 36401-0266
- **Mailing address phone:** (251) 578-3331
- **Mailing address fax:** (251) 578-5277

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DD5370-C | AL | Yes |

## Other

- **Enumeration date:** 10/05/2007
- **Last updated:** 06/17/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 009910742 | — | AL |
| 05 | — | 009995725 | — | AL |