Provider Demographics
NPI:1790505766
Name:MOBILE GENETIX DNA LLC
Entity type:Organization
Organization Name:MOBILE GENETIX DNA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:ANTIONETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK-DOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-331-0808
Mailing Address - Street 1:2617 W GRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-1234
Mailing Address - Country:US
Mailing Address - Phone:734-331-0808
Mailing Address - Fax:
Practice Address - Street 1:2617 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-1234
Practice Address - Country:US
Practice Address - Phone:734-331-0808
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QG0250XAmbulatory Health Care FacilitiesClinic/CenterGenetics