Provider Demographics
NPI:1528278488
Name:MARK A. MOBLEY, DDS, PROF. CORP.
Entity type:Organization
Organization Name:MARK A. MOBLEY, DDS, PROF. CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-341-1459
Mailing Address - Street 1:41592 INDIAN TRL STE A
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 STE A
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0340281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty