Provider Demographics
NPI:1770266512
Name:MOBILE DENTAL XPRESS LLC
Entity type:Organization
Organization Name:MOBILE DENTAL XPRESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-803-3297
Mailing Address - Street 1:1839 LANE AVE S STE 104
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-1260
Mailing Address - Country:US
Mailing Address - Phone:912-667-3873
Mailing Address - Fax:877-770-3699
Practice Address - Street 1:3890 DUNN AVE STE 803
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32218-6429
Practice Address - Country:US
Practice Address - Phone:912-667-3873
Practice Address - Fax:877-770-3699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-09
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty