MEDICARE: MOBILE COMPREHENSIVE DENTAL SERVICES INCORPORATED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1093667230
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOBILE COMPREHENSIVE DENTAL SERVICES INCORPORATED

Provider Business Mailing Address
First Line	:	1839 LANE AVE S STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-1260
Country	:	US
Telephone Number	:	904-300-0126
Fax Number	:	877-770-3699

Provider Business Practice Location Address
First Line	:	1839 LANE AVE S STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32210-1260
Country	:	US
Telephone Number	:	904-300-0126
Fax Number	:	877-770-3699

Authorized Official
Title or Position	:	CREDENTIALING SPECIALIST
Name	:	WENDY KIMBRELL
Credential	:
Telephone Number	:	904-300-0126

Provider Enumeration Date	:	02/11/2026
Last Update Date	:	02/11/2026

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Directions to “MOBILE COMPREHENSIVE DENTAL SERVICES INCORPORATED ” Practice Location

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