Provider Demographics
NPI:1245468982
Name:GARY MOBLEY DDS INC
Entity type:Organization
Organization Name:GARY MOBLEY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MOBLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS,MSC
Authorized Official - Phone:903-463-6013
Mailing Address - Street 1:2230 S EISENHOWER PKWY
Mailing Address - Street 2:
Mailing Address - City:DENISON
Mailing Address - State:TX
Mailing Address - Zip Code:75020-7724
Mailing Address - Country:US
Mailing Address - Phone:903-463-6013
Mailing Address - Fax:903-463-1442
Practice Address - Street 1:2230 S EISENHOWER PKWY
Practice Address - Street 2:
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-7724
Practice Address - Country:US
Practice Address - Phone:903-463-6013
Practice Address - Fax:903-463-1442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKTX9690261QD0000X
TXTX9690261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1265436992OtherNPI PRACTICE
TX009239702Medicaid
TX1265436992OtherNPI PRACTICE