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General NPI Number Information
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NPI Number | 1265067425
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Entity Type | Organization
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Legal Business Name | MOBILE OUTREACH ALLIANCE
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Dates
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Enumeration Date | 03/09/2020
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Last Update Date | 03/09/2020
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Provider Practice Location Address
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Address Line | 8422 W 78TH CIR
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City | ARVADA
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State | CO
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Zip | 80005-4407
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Country | US
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Telephone | 303-506-4698
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Fax |
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Provider Business Mailing Address
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Address Line | 8422 W 78TH CIR
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City | ARVADA
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State | CO
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Zip | 80005-4407
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Country | US
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Telephone | 303-506-4698
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | OLGA ROMANOVNA KOGAN
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Credential |
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Telephone | 303-506-4698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223D0001X
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Taxonomy Name | Public Health Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number |
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License Number State |
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