Provider Demographics
NPI:1730529082
Name:MOBILE DENTAL OF MICHIGAN, PLLC
Entity type:Organization
Organization Name:MOBILE DENTAL OF MICHIGAN, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:AJAY
Authorized Official - Middle Name:V
Authorized Official - Last Name:RAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:773-756-5760
Mailing Address - Street 1:8420 W BRYN MAWR AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60631-3479
Mailing Address - Country:US
Mailing Address - Phone:773-756-5760
Mailing Address - Fax:773-714-1229
Practice Address - Street 1:50749 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48374-2551
Practice Address - Country:US
Practice Address - Phone:773-756-5760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MOBILE ANESTHESIOLOGISTS OF THE MOTOR CITY, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty