# MOBI-DENT P.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1205001914
- **Authorized official:** DR. AVERY CORTEZ POWELL D.D.S. (PRESIDENT)
- **Authorized official phone:** (708) 228-0474

## Contact information

- **Practice address:** 1719 HEATHER HILL CRES, FLOSSMOOR, IL 60422-2041
- **Practice address phone:** (708) 228-0474
- **Practice address fax:** (314) 837-8918
- **Mailing address:** 15652 94TH AVE, FLORISSANT, MO 63034-2175
- **Mailing address phone:** (314) 837-6599
- **Mailing address fax:** (314) 837-8918

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 320700000X | Physical Disabilities Residential Treatment Facility | 019022452 | IL | Yes |

## Other

- **Enumeration date:** 04/23/2008
- **Last updated:** 04/23/2008