Provider Demographics
NPI:1881608750
Name:MOBILE PREMIER PEDIATRIC DENTISTRY, LLC
Entity type:Organization
Organization Name:MOBILE PREMIER PEDIATRIC DENTISTRY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:251-342-3323
Mailing Address - Street 1:3920 AIRPORT BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-2207
Mailing Address - Country:US
Mailing Address - Phone:251-342-3323
Mailing Address - Fax:
Practice Address - Street 1:3920 AIRPORT BLVD
Practice Address - Street 2:STE B
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36608-2207
Practice Address - Country:US
Practice Address - Phone:251-342-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL41411223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty