Healthcare Provider Details

I. General information

NPI: 1538573019
Provider Name (Legal Business Name): RAMY MOUSA D.D.S
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2014
Last Update Date: 06/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

916 CURLEW RD COAST DENTAL
DUNEDIN FL
34698
US

IV. Provider business mailing address

3913 COUNTRY VIEW CIR
SARASOTA FL
34233-4136
US

V. Phone/Fax

Practice location:
  • Phone: 727-736-1777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN20700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: