Provider Demographics
NPI:1669269361
Name:MIDWEST DIRECT MOBILE DENTAL, TAIWO NGO LLC
Entity type:Organization
Organization Name:MIDWEST DIRECT MOBILE DENTAL, TAIWO NGO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAIWO
Authorized Official - Middle Name:
Authorized Official - Last Name:NGO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:313-574-8541
Mailing Address - Street 1:7907 QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9447
Mailing Address - Country:US
Mailing Address - Phone:313-574-8541
Mailing Address - Fax:
Practice Address - Street 1:7907 QUARRY RD
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-9447
Practice Address - Country:US
Practice Address - Phone:313-574-8541
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2166294Medicaid