Provider Demographics
NPI:1073084307
Name:MOBILE DENTAL CARE OF FLORIDA LLC
Entity Type:Organization
Organization Name:MOBILE DENTAL CARE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:BARTHOLOMEW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-450-2112
Mailing Address - Street 1:PO BOX 61168
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33906-1168
Mailing Address - Country:US
Mailing Address - Phone:239-450-2112
Mailing Address - Fax:
Practice Address - Street 1:1431 POINCIANA AVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-5926
Practice Address - Country:US
Practice Address - Phone:239-450-2112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty