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General NPI Number Information
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NPI Number | 1306492442
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Entity Type | Individual
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Provider Name | SHANE ALLEN MOBLEY DMD
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Gender | Male
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Dates
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Enumeration Date | 08/14/2019
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Last Update Date | 03/14/2022
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Provider Practice Location Address
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Address Line | 450 TURNER ST UNIT 3600
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City | PENSACOLA
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State | FL
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Zip | 32508-5211
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Country | US
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Telephone | 904-483-0689
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Fax |
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Provider Business Mailing Address
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Address Line | 1912 LODGEPOLE DR
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City | MILTON
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State | FL
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Zip | 32583-9178
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN24252
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License Number State | FL
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