Provider Demographics
NPI:1760103873
Name:WE CARE MOBILE DENTAL FOUNDATION
Entity Type:Organization
Organization Name:WE CARE MOBILE DENTAL FOUNDATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMOKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-320-4462
Mailing Address - Street 1:6523 WALSH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2646
Mailing Address - Country:US
Mailing Address - Phone:314-320-4462
Mailing Address - Fax:
Practice Address - Street 1:6523 WALSH ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-2646
Practice Address - Country:US
Practice Address - Phone:314-320-4462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1447475561Medicaid