EVERGREEN DENTAL CENTER (NPI# 1518155373) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518155373 |
| Entity Type | Organization |
| Organization Name | EVERGREEN DENTAL CENTER |
| Other Organization Name | FORT DEPOSIT DENTAL CENTER |
| Practice Address |
119 Old Fort Road Suite B Fort Deposit AL 36032 |
| Mailing Address |
Po Box 266 100 Edwina Street Evergreen AL 36401-0266 |
| Practice Telephone | 3342274000 |
| Practice Fax Number | 3342273770 |
| Mailing Telephone | 2515783331 |
| Mailing Fax Number | 2515785277 |
| Enumeration Date | 2007-10-05 |
| Last Update Date | 2008-06-17 |
| Authorized Official Name | DR. ROBERT P LOUIS (EXECUTIVE DIRECTOR) |
| Authorized Official Telephone | 2515783331 |
| Authorized Official Credential | DDS MPH |
| Is Organization Subpart | Y |
| Parent Organization Name | EVERGREEN DENTAL CENTER |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | DD5370-C | AL | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| AL | 009910742 | 05 | |
| AL | 009995725 | 05 |
| Other Name | Type Code |
|---|---|
| Fort Deposit Dental Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1467526038 | Evergreen Dental Center | Dentist | 100 Edwina Street, Evergreen, AL 36401 | 2006-11-17 |
| Street Address |
119 OLD FORT ROAD SUITE B |
| City | FORT DEPOSIT |
| State | AL |
| Zip Code | 36032 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770762643 | Phillip N. Golomb, Md Pa | Family Medicine | 19 Milner Street, Fort Deposit, AL 36032 | 2007-10-29 |
| 1407985344 | Tri County Medical Center, Inc | Clinic/Center | 1 Milner St, Fort Deposit, AL 36032-3820 | 2007-03-05 |
| 1124203211 | Fort Deposit Drug Pharmacy LLC | Pharmacy | 120 S Pollard St, Fort Deposit, AL 36032-3825 | 2008-01-08 |
| 1467978346 | Herbert Lamar Barber Jr. | Registered Nurse | 554 Golson Rd E, Fort Deposit, AL 36032-4508 | 2017-08-22 |
| 1508230988 | Kimberly Nacole Jordan | Occupational Therapist | 435 Pine St, Fort Deposit, AL 36032-4740 | 2015-11-22 |
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1881292845 | Matthew Thomas Rurka | Dentist | 4685 Highway 17 Ste C, Helena, AL 35080-3560 | 2020-10-13 |
| 1760089619 | Daniel Brumley | Dentist | 3400 Montgomery Hwy Ste 1, Dothan, AL 36303-1270 | 2020-10-05 |
| 1457963787 | Carrie Ann Cochran | Dentist | 1995 Pepperell Pkwy Ste 1, Opelika, AL 36801-5460 | 2020-08-18 |
| 1689286254 | Rajdeepsinh Narendrasinh Dolia | Dentist | 12205 County Line Rd Ste A, Madison, AL 35758-7720 | 2020-08-17 |
| 1497365498 | Krina Patel | Dentist | 101 6th Ave Nw, Jasper, AL 35504-7486 | 2020-08-04 |
| 1992329700 | Forrest Hunter Harris | Dentist | 1551 E Trinity Blvd, Montgomery, AL 36106-3802 | 2020-06-08 |
| 1609499169 | Tanya Tamiki Hollinshed-miles | Dentist | 1304 Beech St, Montgomery, AL 36113-1002 | 2020-05-19 |
| 1891327904 | Vital Smiles Alabama II PC | Dentist | 809 Beltline Rd Sw Ste A, Decatur, AL 35601-6337 | 2020-02-06 |
| 1689217309 | Stonecreek Dental of Alabama | Dentist | 1840 Montclaire Dr, Vestavia Hills, AL 35216-1408 | 2019-10-25 |
| 1013558766 | Southern Smiles | Dentist | 2801 John Hawkins Pkwy Ste 175, Hoover, AL 35244-4007 | 2019-10-03 |
| Find all providers with the same taxonomy | ||||
| City | FORT DEPOSIT |
| Zip Code | 36032 |
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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.