Mobile Dental Management, LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6593 Issued in TX

Legal business name

MOBILE DENTAL MANAGEMENT, LLC

Doing business as

Keen Dental Health

Practice address

1813 Grandstand Dr
San Antonio, TX 78238-4701

Phone

(210) 569-2650

NPI assigned

May 12, 2014

Organization subpart

No

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

Authorized official

Name

Pegeen Moira Kramer, MBA, MED

Title

President

Phone

(210) 569-2650

Specialties & licenses 2

Addresses

Other identifiers 2

Other names 1

• Keen Dental Health Doing business as

Locations

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

{
    "created_epoch": "1399852800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1399852800000",
    "number": "1346651478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "926 WINDMILL PALM",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782168004",
            "telephone_number": "210-569-2650"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1813 GRANDSTAND DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782384701",
            "telephone_number": "210-569-2650"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DENTAL MANAGEMENT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-05-12",
        "last_updated": "2014-05-12",
        "status": "A",
        "authorized_official_last_name": "KRAMER",
        "authorized_official_first_name": "PEGEEN",
        "authorized_official_middle_name": "MOIRA",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "210-569-2650",
        "authorized_official_credential": "MBA, MED"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "12325",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "6593",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "167017602",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "120877902",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keen Dental Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melissa A Moa
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• Charlotte Moats, OTR/L
• Shohreh Moaveni
• Nicole Moazami, RN
• Mobile Psych PLLC
• Mobility Advantage, Inc.
• Mobility Express Plus LLC
• Tamara L. Mobley-Wicker
• Branden Mobley

• General Practice Dentistry in San Antonio, TX
• Providers in San Antonio, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2014; 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.