Provider Demographics
NPI:1972006682
Name:MUNDO DENTAL GROUP, PA
Entity Type:Organization
Organization Name:MUNDO DENTAL GROUP, PA
Other - Org Name:MUNDO DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:704-825-2081
Mailing Address - Street 1:3463 HIGHWAY 21 BYP STE 101
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29715-7210
Mailing Address - Country:US
Mailing Address - Phone:704-825-2081
Mailing Address - Fax:
Practice Address - Street 1:3463 HIGHWAY 21 BYP STE 101
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29715-7210
Practice Address - Country:US
Practice Address - Phone:704-825-2081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-09
Last Update Date:2018-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty