Provider Demographics
NPI:1922450220
Name:MOBILE DENTAL HYGIENE SERVICES, LLP
Entity Type:Organization
Organization Name:MOBILE DENTAL HYGIENE SERVICES, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PUBLIC HEALTH DENTAL HYGIENIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:VIOLA
Authorized Official - Last Name:SIMISON
Authorized Official - Suffix:
Authorized Official - Credentials:RDH, MS
Authorized Official - Phone:443-907-7309
Mailing Address - Street 1:PO BOX 435
Mailing Address - Street 2:
Mailing Address - City:FORESTDALE
Mailing Address - State:MA
Mailing Address - Zip Code:02644-0435
Mailing Address - Country:US
Mailing Address - Phone:508-827-6725
Mailing Address - Fax:
Practice Address - Street 1:14 JAN SEBASTIAN DR STE C
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:MA
Practice Address - Zip Code:02563-2384
Practice Address - Country:US
Practice Address - Phone:508-827-6725
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-11
Last Update Date:2016-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADH88043251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare