Provider Demographics
NPI:1134782576
Name:MOBILE DENTAL CARE OF DELAWARE PA
Entity type:Organization
Organization Name:MOBILE DENTAL CARE OF DELAWARE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LEWIS
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-304-4476
Mailing Address - Street 1:2314 ROUTE 59
Mailing Address - Street 2:SUITE 384
Mailing Address - City:PLANIFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586
Mailing Address - Country:US
Mailing Address - Phone:708-744-9188
Mailing Address - Fax:708-429-5715
Practice Address - Street 1:239 CYPRESS AVE
Practice Address - Street 2:
Practice Address - City:LINDENWOLD
Practice Address - State:NJ
Practice Address - Zip Code:08021
Practice Address - Country:US
Practice Address - Phone:708-744-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-22
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty