Healthcare Provider Details

I. General information

NPI: 1255775979
Provider Name (Legal Business Name): MOBILE DENTAL CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2013
Last Update Date: 04/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 AZALEA RD
MOBILE AL
36609-1501
US

IV. Provider business mailing address

515 AZALEA RD
MOBILE AL
36609-1501
US

V. Phone/Fax

Practice location:
  • Phone: 251-648-8936
  • Fax: 251-964-4012
Mailing address:
  • Phone: 251-648-8936
  • Fax: 251-964-4012

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberLNO-5776
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License NumberLNO-5776
License Number StateAL

VIII. Authorized Official

Name: DR. UYEN N HOANG
Title or Position: DENTIST
Credential: DMD
Phone: 251-648-8936