Provider Demographics
NPI:1093173270
Name:GRAYHILLS AND MOHIP DENTISTRY PARTNERSHIP
Entity Type:Organization
Organization Name:GRAYHILLS AND MOHIP DENTISTRY PARTNERSHIP
Other - Org Name:GRAYHILLS AND MOHIP DENTAL
Other - Org Type:Other Name
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VIKRAM
Authorized Official - Middle Name:VASUDEV
Authorized Official - Last Name:MOHIP
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-798-1600
Mailing Address - Street 1:250 PROFESSIONAL WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-6391
Mailing Address - Country:US
Mailing Address - Phone:561-798-1600
Mailing Address - Fax:561-798-1269
Practice Address - Street 1:250 PROFESSIONAL WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6391
Practice Address - Country:US
Practice Address - Phone:561-798-1600
Practice Address - Fax:561-798-1269
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-03
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16028122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty