Healthcare Provider Details

I. General information

NPI: 1366359887
Provider Name (Legal Business Name): LAKISHA D MOSS CRDH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 08/27/2026
Certification Date: 08/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 NW 20TH ST
MIAMI FL
33127-4622
US

IV. Provider business mailing address

222 S 56TH TER
HOLLYWOOD FL
33023-1474
US

V. Phone/Fax

Practice location:
  • Phone: 305-321-2985
  • Fax:
Mailing address:
  • Phone: 305-321-2985
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH19284
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: