Mobile Dental Head- Start LLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

MOBILE DENTAL HEAD- START LLC

Practice address

1839 Lane Ave S Ste 104
Jacksonville, FL 32210-1260

Phone

(904) 300-0126

NPI assigned

Oct 15, 2024

Last updated

Oct 24, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Kenjula Brown

Title

Owner

Phone

(904) 300-0126

Specialties & licenses 1

Addresses

Other names 1

• MOBILE DENTAL HEAD - START LLC Former legal business name

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

{
    "created_epoch": "1728950400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1729728000000",
    "number": "1356161293",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1839 LANE AVE S STE 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101260",
            "telephone_number": "904-300-0126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1839 LANE AVE S STE 104",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322101260",
            "telephone_number": "904-300-0126"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOBILE DENTAL HEAD- START LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-10-15",
        "last_updated": "2024-10-24",
        "certification_date": "2024-10-24",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "KENJULA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "904-300-0126"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MOBILE DENTAL HEAD - START LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "MOBILE DENTAL HEAD - START LLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Mkkinetics LLC
• Mla ENT FL, Inc
• Denitza Issaeva Mladenova, RD, LD/N
• Mob Enterprises LLC (Mobility Plus of Jacksonville)
• Mobile Comprehensive Dental Services Incorporated
• Mobile Dental Xpress LLC
• Mobile Dental Xpress Management Group LLC
• Mobile PT Solutions, LLC
• Mobilebio
• Mobility Equipment LLC

• General Practice Dentistry in Jacksonville, FL
• Providers in Jacksonville, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2024; 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.