Provider Demographics
NPI:1881051266
Name:MOBI DENTI
Entity type:Organization
Organization Name:MOBI DENTI
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-869-7426
Mailing Address - Street 1:675 VFW PKWY
Mailing Address - Street 2:#106
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3656
Mailing Address - Country:US
Mailing Address - Phone:617-869-7426
Mailing Address - Fax:
Practice Address - Street 1:675 VFW PKWY
Practice Address - Street 2:#106
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3656
Practice Address - Country:US
Practice Address - Phone:617-869-7426
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-15
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21341261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental