Provider Demographics
NPI:1245645084
Name:MOBILE DENTAL SERVICES OF ALABAMA PC
Entity type:Organization
Organization Name:MOBILE DENTAL SERVICES OF ALABAMA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PENELOPE
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLINE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:773-329-4450
Mailing Address - Street 1:10 S RIVERSIDE PLZ
Mailing Address - Street 2:19 EAST
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60606-3728
Mailing Address - Country:US
Mailing Address - Phone:888-970-3400
Mailing Address - Fax:
Practice Address - Street 1:3231 FIELDSTONE DR SW
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35603-3173
Practice Address - Country:US
Practice Address - Phone:205-568-4213
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-30
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty