Fort Deposit Dental Center | |
119 Old Fort Road Suite B Fort Deposit AL 36032 | |
(334) 227-4000 | |
(334) 227-3770 |
Full Name | Fort Deposit Dental Center |
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Speciality | Dentist |
Location | 119 Old Fort Road, Fort Deposit, Alabama |
Authorized Official Name and Position | Robert P Louis (EXECUTIVE DIRECTOR) |
Authorized Official Contact | 2515783331 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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Fort Deposit Dental Center Po Box 266 100 Edwina Street Evergreen AL 36401-0266 Ph: (251) 578-3331 | Fort Deposit Dental Center 119 Old Fort Road Suite B Fort Deposit AL 36032 Ph: (334) 227-4000 |
NPI Number | 1518155373 |
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Provider Enumeration Date | 10/05/2007 |
Last Update Date | 06/17/2008 |
Identifier | Type | State | Issuer |
---|---|---|---|
1518155373 | NPI | - | NPPES |
009910742 | Medicaid | AL | |
009995725 | Medicaid | AL |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
122300000X | Dentist | DD5370-C (Alabama) | Primary |