Provider Demographics
NPI:1629166509
Name:AMERICAN MOBILE DENTAL PC
Entity Type:Organization
Organization Name:AMERICAN MOBILE DENTAL PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOY
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHTENEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-628-5535
Mailing Address - Street 1:24293 TELEGRAPH RD STE 212
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48033-7903
Mailing Address - Country:US
Mailing Address - Phone:888-628-5535
Mailing Address - Fax:888-892-3080
Practice Address - Street 1:24293 TELEGRAPH RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48033-7903
Practice Address - Country:US
Practice Address - Phone:888-628-5535
Practice Address - Fax:888-892-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2016-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty