Provider Demographics
NPI:1376869024
Name:MOBILE MEDICAL AND DENTAL SERVICES, P.C.
Entity Type:Organization
Organization Name:MOBILE MEDICAL AND DENTAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:CREVIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-250-6175
Mailing Address - Street 1:9716 S LONGWOOD DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1610
Mailing Address - Country:US
Mailing Address - Phone:708-250-6175
Mailing Address - Fax:
Practice Address - Street 1:9716 S LONGWOOD DR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1610
Practice Address - Country:US
Practice Address - Phone:708-250-6175
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.021712122300000X
IL036.074856207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty