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General NPI Number Information
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NPI Number | 1770266512
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Entity Type | Organization
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Legal Business Name | MOBILE DENTAL XPRESS LLC
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Dates
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Enumeration Date | 08/09/2023
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 3890 DUNN AVE STE 803
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City | JACKSONVILLE
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State | FL
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Zip | 32218-6429
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Country | US
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Telephone | 912-667-3873
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Fax | 877-770-3699
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Provider Business Mailing Address
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Address Line | 1839 LANE AVE S STE 104
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City | JACKSONVILLE
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State | FL
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Zip | 32210-1260
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Country | US
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Telephone | 912-667-3873
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Fax | 877-770-3699
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | SONYA DUNBAR
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Credential |
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Telephone | 904-803-3297
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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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