Provider Demographics
NPI:1336887926
Name:MOBILE DENTAL CARE OF GEORGIA PC
Entity Type:Organization
Organization Name:MOBILE DENTAL CARE OF GEORGIA PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEETS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:888-970-3400
Mailing Address - Street 1:2314 S ROUTE 59 STE 384
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60586-7756
Mailing Address - Country:US
Mailing Address - Phone:888-970-3400
Mailing Address - Fax:888-456-3812
Practice Address - Street 1:3413 FLAT RUN DR
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:GA
Practice Address - Zip Code:30620-4681
Practice Address - Country:US
Practice Address - Phone:888-970-3400
Practice Address - Fax:888-456-3812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-24
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty