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General NPI Number Information
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NPI Number | 1245645084
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Entity Type | Organization
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Legal Business Name | MOBILE DENTAL SERVICES OF ALABAMA PC
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Dates
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Enumeration Date | 06/30/2014
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Last Update Date | 06/30/2014
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Provider Practice Location Address
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Address Line | 3231 FIELDSTONE DR SW
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City | DECATUR
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State | AL
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Zip | 35603-3173
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Country | US
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Telephone | 205-568-4213
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Fax |
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Provider Business Mailing Address
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Address Line | 10 S RIVERSIDE PLZ 19 EAST
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City | CHICAGO
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State | IL
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Zip | 60606-3728
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Country | US
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Telephone | 888-970-3400
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. PENELOPE C CLINE
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Credential | DMD
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Telephone | 773-329-4450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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