Provider Demographics
NPI:1104369370
Name:MOBILECARE DENTAL, PLLC
Entity Type:Organization
Organization Name:MOBILECARE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-806-1852
Mailing Address - Street 1:2729 RUDY RD
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-2936
Mailing Address - Country:US
Mailing Address - Phone:479-471-1677
Mailing Address - Fax:
Practice Address - Street 1:2729 RUDY RD
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-2936
Practice Address - Country:US
Practice Address - Phone:479-471-1677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-21
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1190261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental