Provider Demographics
NPI:1174004170
Name:INTEGRITY MOBILE DENTAL, LLC
Entity Type:Organization
Organization Name:INTEGRITY MOBILE DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:SUMMITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-535-5030
Mailing Address - Street 1:802 S CREST RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37404-5923
Mailing Address - Country:US
Mailing Address - Phone:855-535-5030
Mailing Address - Fax:855-535-5030
Practice Address - Street 1:802 S CREST RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-5923
Practice Address - Country:US
Practice Address - Phone:855-535-5030
Practice Address - Fax:855-535-5030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS88061223D0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty