Provider Demographics
NPI:1609416999
Name:MOBILE DENTAL CARE ASSOCIATE LLC
Entity Type:Organization
Organization Name:MOBILE DENTAL CARE ASSOCIATE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:475-238-8165
Mailing Address - Street 1:55 SARGENT DRIVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:CT
Mailing Address - Zip Code:06524-3135
Mailing Address - Country:US
Mailing Address - Phone:475-238-8165
Mailing Address - Fax:475-655-2967
Practice Address - Street 1:55 SARGENT DRIVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:CT
Practice Address - Zip Code:06524-3135
Practice Address - Country:US
Practice Address - Phone:475-238-8165
Practice Address - Fax:475-655-2967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty