MEDICARE: DR. MOIZ MOHAMMED ABDUL DDS,MS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	33139	TX

General Provider Information

NPI Number	:	1194246702
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOIZ MOHAMMED ABDUL DDS,MS

Provider Business Mailing Address
First Line	:	110 HOWARD DR APT T
Second Line	:
City	:	BERGENFIELD
State	:	NJ
Zip	:	07621-5427
Country	:	US
Telephone Number	:	12013007144
Fax Number	:

Provider Business Practice Location Address
First Line	:	1641 NILE DR
Second Line	:	APT - 223
City	:	CORPUS CHRISTI
State	:	TX
Zip	:	78415-7841
Country	:	US
Telephone Number	:	361-854-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2017
Last Update Date	:	07/05/2017

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