Provider Demographics
NPI:1255775979
Name:MOBILE DENTAL CARE PC
Entity type:Organization
Organization Name:MOBILE DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:UYEN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-648-8936
Mailing Address - Street 1:515 AZALEA RD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36609-1501
Mailing Address - Country:US
Mailing Address - Phone:251-648-8936
Mailing Address - Fax:251-964-4012
Practice Address - Street 1:515 AZALEA RD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36609-1501
Practice Address - Country:US
Practice Address - Phone:251-648-8936
Practice Address - Fax:251-964-4012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALLNO-5776261QD0000X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL124007Medicaid
AL124009Medicaid
ALLNO-5776OtherSTATE LICENSE