Organization
MOBI-DENT P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. AVERY CORTEZ POWELL D.D.S. (PRESIDENT)
(708) 228-0474
Entity
Organization
Contact information
Practice address
1719 HEATHER HILL CRES, FLOSSMOOR, IL 60422-2041
(708) 228-0474
(314) 837-8918
Mailing address
15652 94TH AVE, FLORISSANT, MO 63034-2175
(314) 837-6599
(314) 837-8918
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
019022452
IL
Other
Enumeration date
04/23/2008
Last updated
04/23/2008
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