Provider Demographics
NPI:1366611568
Name:MOBLEY, MARK ANTHONY (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ANTHONY
Last Name:MOBLEY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41592 INDIAN TRL
Mailing Address - Street 2:
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-5401
Mailing Address - Country:US
Mailing Address - Phone:760-341-1459
Mailing Address - Fax:760-568-4120
Practice Address - Street 1:41592 INDIAN TRL
Practice Address - Street 2:
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-5401
Practice Address - Country:US
Practice Address - Phone:760-341-1459
Practice Address - Fax:760-568-4120
Is Sole Proprietor?:No
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0340281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA034028OtherDENTAL LICENSE