Provider Demographics
NPI:1487998134
Name:DISTRICT MOBILE DENTAL LLC
Entity type:Organization
Organization Name:DISTRICT MOBILE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:MARC
Authorized Official - Last Name:DUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:301-977-3766
Mailing Address - Street 1:37 MARYLAND AVE
Mailing Address - Street 2:235
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2437
Mailing Address - Country:US
Mailing Address - Phone:240-599-0773
Mailing Address - Fax:
Practice Address - Street 1:37 MARYLAND AVE
Practice Address - Street 2:235
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-2437
Practice Address - Country:US
Practice Address - Phone:240-552-9077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-19
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD84571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty