NPIMap

Organization Active NPI

Mobi-Dent P.C.

  • Physical Disabilities Residential Treatment Facility
  • Flossmoor, IL
National Provider Identifier
1205001914
Registry record updated Apr 23, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Disabilities Residential Treatment FacilityTaxonomy code 320700000X
License
019022452 Issued in IL
Legal business name
MOBI-DENT P.C.
Practice address
1719 Heather Hill Cres
Flossmoor, IL 60422-2041
Phone
(708) 228-0474
Fax
(314) 837-8918
NPI assigned
Apr 23, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 23, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Avery Cortez Powell, D.D.S.NPI 1639383060
Title
President
Phone
(708) 228-0474

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Disabilities Residential Treatment Facility 320700000X 019022452 IL Primary

Addresses

Primary practice location

1719 Heather Hill Cres
Flossmoor, IL 60422-2041

Mailing address

15652 94TH Ave
Florissant, MO 63034-2175
Phone (314) 837-6599

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1208908800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1208908800000",
    "number": "1205001914",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15652 94TH AVE",
            "city": "FLORISSANT",
            "state": "MO",
            "postal_code": "630342175",
            "telephone_number": "314-837-6599",
            "fax_number": "314-837-8918"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1719 HEATHER HILL CRES",
            "city": "FLOSSMOOR",
            "state": "IL",
            "postal_code": "604222041",
            "telephone_number": "708-228-0474",
            "fax_number": "314-837-8918"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBI-DENT P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-04-23",
        "last_updated": "2008-04-23",
        "status": "A",
        "authorized_official_last_name": "POWELL",
        "authorized_official_first_name": "AVERY",
        "authorized_official_middle_name": "CORTEZ",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "708-228-0474",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.D.S."
    },
    "taxonomies": [
        {
            "code": "320700000X",
            "taxonomy_group": "",
            "desc": "Residential Treatment Facility, Physical Disabilities",
            "state": "IL",
            "license": "019022452",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Flossmoor, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.